MEDICARE: REDWOOD REGIONAL MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085N0700X	Neuroradiology Physician
2	2085N0904X	Nuclear Radiology Physician
3	2085R0202X	Diagnostic Radiology Physician
4	2085B0100X	Body Imaging 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	:	1982791380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD REGIONAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	652 PETALUMA AVE STE I
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-829-2141
Fax Number	:	707-829-2966

Provider Business Practice Location Address
First Line	:	652 PETALUMA AVE
Second Line	:	SUITE I
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4256
Country	:	US
Telephone Number	:	707-829-2141
Fax Number	:	707-829-2966

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HELEN COLLINS
Credential	:	M.D.
Telephone Number	:	707-546-4062

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	11/15/2007

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Directions to “REDWOOD REGIONAL MEDICAL GROUP ” Practice Location

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