=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356540306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLOWS FAMILY PRACTICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 W SYCAMORE ST
-----------------------------------------------------
City | WILLOWS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95988-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-934-3385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 466
-----------------------------------------------------
City | WILLOWS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95988-0466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-934-3385
-----------------------------------------------------
Fax | 530-934-3387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MICHELL L KNIGHT
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 530-934-3385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------