MEDICARE: REDWOOD REGIONAL MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician
2	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215016993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD REGIONAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	347 ANDRIEUX ST STE 1
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6811
Country	:	US
Telephone Number	:	707-935-5460
Fax Number	:	707-935-5466

Provider Business Practice Location Address
First Line	:	625 STEELE LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3127
Country	:	US
Telephone Number	:	707-935-5460
Fax Number	:	707-935-5466

Authorized Official
Title or Position	:	M.D./RADIOLOGIST
Name	:	DAVID H. SCHMIDT
Credential	:	M.D.
Telephone Number	:	707-546-4062

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	11/13/2007

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