Provider Demographics
NPI:1275778847
Name:REDWOOD COAST MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:REDWOOD COAST MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-882-1704
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1100
Mailing Address - Country:US
Mailing Address - Phone:707-882-1704
Mailing Address - Fax:707-882-2667
Practice Address - Street 1:30 MILL STREET
Practice Address - Street 2:
Practice Address - City:POINT ARENA
Practice Address - State:CA
Practice Address - Zip Code:95468-9902
Practice Address - Country:US
Practice Address - Phone:707-882-1704
Practice Address - Fax:707-882-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000361261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551078Medicare Oscar/Certification