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NPI Code Detail

MEDICARE: NORTH JETTY HOSPITALISTS INC A MEDICAL CORPORATION

MEDICARE: NORTH JETTY HOSPITALISTS INC A MEDICAL CORPORATION
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
1207P00000XEmergency Medicine Physician202545078CA

Other Identifiers

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

General Provider Information

NPI Number : 1306887765
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH JETTY HOSPITALISTS INC A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 60039
Second Line :
City : ARCADIA
State : CA
Zip : 91066-6039
Country : US
Telephone Number : 626-447-0296
Fax Number : 626-447-6057
Provider Business Practice Location Address
First Line : 3800 JANES ROAD
Second Line :
City : ARCATA
State : CA
Zip : 95521-4742
Country : US
Telephone Number : 707-822-3621
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : STEFAN E SCHUNK
Credential : MD
Telephone Number : 707-822-3621
Provider Enumeration Date : 06/09/2006
Last Update Date : 06/17/2008

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Directions to “NORTH JETTY HOSPITALISTS INC A MEDICAL CORPORATION ” Practice Location

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