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NPI Code Detail

MEDICARE: ST MORITZ MEDICAL CENTER INC

MEDICARE: ST MORITZ MEDICAL CENTER 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
1207Q00000XFamily Medicine Physician
2207Q00000XFamily Medicine Physician20A4866CA

General Provider Information

NPI Number : 1336126499
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MORITZ MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 202 PROVIDENCE MINE RD STE 105
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2945
Country : US
Telephone Number : 530-264-7475
Fax Number : 916-318-6950
Provider Business Practice Location Address
First Line : 202 PROVIDENCE MINE RD STE 105
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2945
Country : US
Telephone Number : 530-264-7475
Fax Number : 916-318-6950
Authorized Official
Title or Position : PRESIDENT
Name : LINDA KAY FOSHAGEN
Credential : DO
Telephone Number : 530-264-7475
Provider Enumeration Date : 12/29/2005
Last Update Date : 08/16/2018

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Directions to “ST MORITZ MEDICAL CENTER INC ” Practice Location

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