Provider Demographics
NPI:1073572582
Name:NAPA VALLEY NEPHROLOGY & INTERNAL MEDICINE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NAPA VALLEY NEPHROLOGY & INTERNAL MEDICINE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-252-8407
Mailing Address - Street 1:3443 VILLA LN
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-252-8407
Mailing Address - Fax:707-252-8335
Practice Address - Street 1:3443 VILLA LN
Practice Address - Street 2:SUITE 6
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-252-8407
Practice Address - Fax:707-252-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X, 207RG0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0024510Medicaid
CAZZZ24249ZMedicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER