MEDICARE: NORTHERN CALIFORNIA MEDICAL ASSOC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	207RI0011X	Interventional Cardiology Physician
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
4	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ36920Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184845182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN CALIFORNIA MEDICAL ASSOC INC

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 200
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3634
Country	:	US
Telephone Number	:	707-525-6485
Fax Number	:	707-573-6918

Provider Business Practice Location Address
First Line	:	652 PETALUMA AVE
Second Line	:	STE E
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-573-6166
Fax Number	:	707-573-6165

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. RUTH A. SKIDMORE
Credential	:
Telephone Number	:	707-573-6925

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	10/01/2007

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Directions to “NORTHERN CALIFORNIA MEDICAL ASSOC INC ” Practice Location

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