Provider Demographics
NPI:1023181971
Name:KEVIN J CALDWELL MD INC
Entity Type:Organization
Organization Name:KEVIN J CALDWELL MD INC
Other - Org Name:REDWOOD MEDICAL OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:SPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-465-5566
Mailing Address - Street 1:1240 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531
Mailing Address - Country:US
Mailing Address - Phone:707-465-5566
Mailing Address - Fax:707-465-4990
Practice Address - Street 1:1240 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531
Practice Address - Country:US
Practice Address - Phone:707-465-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49108Medicare UPIN
E08789Medicare UPIN
CAE08789Medicare UPIN