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NPI Code Detail

MEDICARE: PETALUMA HEALTH CENTER INC

MEDICARE: PETALUMA HEALTH 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
1261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4551879OTHERCAMEDICARE NGS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588656268
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETALUMA HEALTH CENTER INC
Provider Business Mailing Address
First Line : 1179 N MCDOWELL BLVD
Second Line :
City : PETALUMA
State : CA
Zip : 94954-6559
Country : US
Telephone Number : 707-559-7597
Fax Number : 707-658-1319
Provider Business Practice Location Address
First Line : 1179 N MCDOWELL BLVD
Second Line :
City : PETALUMA
State : CA
Zip : 94954-6559
Country : US
Telephone Number : 707-559-7500
Fax Number : 707-559-7620
Authorized Official
Title or Position : CEO
Name : KATHRYN POWELL
Credential :
Telephone Number : 707-559-7500
Provider Enumeration Date : 08/18/2005
Last Update Date : 03/24/2022

Similar Medicare Providers

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Practice Location Address:
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Practice Fax:
1942809256 — RACHEL PRADARELLI
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Practice Fax:
1124029491 — DR. PHILIPPE EDOUARD MD
Practice Location Address:
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1255323945 — FIONA REDWOOD M.D.
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Practice Fax: 707-559-7570
1376535070 — DANIELLE ORYN D.O.
Practice Location Address:
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Practice Phone: 707-559-7500
Practice Fax: 707-559-7620
1326030024 — JOHN PENDLETON M.D.
Practice Location Address:
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94954-6559
Practice Phone: 707-559-7500
Practice Fax: 707-559-7620

Directions to “PETALUMA HEALTH CENTER INC ” Practice Location

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