Provider Demographics
NPI:1275556607
Name:REDWOOD REGIONAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:REDWOOD REGIONAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-525-6691
Mailing Address - Street 1:121 SOTOYOME ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4823
Mailing Address - Country:US
Mailing Address - Phone:707-525-6124
Mailing Address - Fax:707-525-4093
Practice Address - Street 1:3555 ROUND BARN CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1757
Practice Address - Country:US
Practice Address - Phone:707-525-6124
Practice Address - Fax:707-525-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X, 2085R0001X, 2085R0202X, 2085R0204X, 208600000X, 2086S0129X, 363L00000X
CA05D0612494291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0049201Medicaid
CAZZZ83873ZMedicaid
CAZZZ13690ZMedicare PIN
CAZZZ45723ZMedicare PIN
CAZZZ00465ZMedicare PIN
CAZZZ00471ZMedicare PIN
CAZZZ00532ZMedicare PIN
CAZZZ27964ZMedicare PIN
CAZZZ00468ZMedicare PIN
CAZZZ00469ZMedicare PIN
CAZZZ00533ZMedicare PIN
CAGR0049201Medicaid
CAZZZ00525ZMedicare PIN
CAZZZ45722ZMedicare PIN
CAZZZ00467ZMedicare PIN
CAZZZ00470ZMedicare PIN
CAZZZ00528ZMedicare PIN
CAZZZ45724ZMedicare PIN