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General NPI Number Information
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NPI Number | 1447287347
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Entity Type | Organization
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Legal Business Name | HUMBOLDT FAMILY MEDICAL CARE
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 1733 CENTRAL AVE
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-3601
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Country | US
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Telephone | 707-839-4852
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Fax | 707-839-2439
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Provider Business Mailing Address
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Address Line | P.O. BOX 4957
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City | ARCATA
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State | CA
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Zip | 95518-4957
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Country | US
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Telephone | 707-822-7220
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Fax | 707-826-8258
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DOUGLAS ALLEN SHAW
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Credential |
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Telephone | 707-822-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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