Healthcare Provider Details

I. General information

NPI: 1356540306
Provider Name (Legal Business Name): WILLOWS FAMILY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W SYCAMORE ST
WILLOWS CA
95988-2832
US

IV. Provider business mailing address

PO BOX 466
WILLOWS CA
95988-0466
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-3385
  • Fax:
Mailing address:
  • Phone: 530-934-3385
  • Fax: 530-934-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELL L KNIGHT
Title or Position: CO-OWNER
Credential: PA-C
Phone: 530-934-3385