Provider Demographics
NPI:1316034630
Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Other - Org Name:REDWOOD REGIONAL ONCOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-546-4062
Mailing Address - Street 1:1165 S DORA ST BLDG H
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-8325
Mailing Address - Country:US
Mailing Address - Phone:707-463-3636
Mailing Address - Fax:707-463-2714
Practice Address - Street 1:1165 S DORA ST BLDG H
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-8325
Practice Address - Country:US
Practice Address - Phone:707-463-3636
Practice Address - Fax:707-463-2714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOOD REGIONAL MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058130Medicaid
CAGR0058130Medicaid