Provider Demographics
NPI:1215006143
Name:ALDIS BALTINS
Entity Type:Organization
Organization Name:ALDIS BALTINS
Other - Org Name:MENDOCINO ORTHOPEDIC MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-468-0471
Mailing Address - Street 1:1165 S DORA ST
Mailing Address - Street 2:SUITE C1
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-468-0471
Mailing Address - Fax:707-468-1182
Practice Address - Street 1:1165 S DORA ST
Practice Address - Street 2:SUITE C1
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-468-0471
Practice Address - Fax:707-468-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78023ZMedicaid
CA0801030001OtherCIGNA DMERC REGION D
CA195914700OtherDEPT OF LABOR WORKCOMP
CACP5457OtherRAILROAD MEDICARE
CAZZZ78023ZMedicare ID - Type Unspecified
CA0801030001Medicare NSC