Provider Demographics
NPI:1366654238
Name:WOODLAND NEPHROLOGY MED GRP
Entity Type:Organization
Organization Name:WOODLAND NEPHROLOGY MED GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-668-3600
Mailing Address - Street 1:520 COTTONWOOD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3603
Mailing Address - Country:US
Mailing Address - Phone:530-668-3600
Mailing Address - Fax:530-668-3601
Practice Address - Street 1:520 COTTONWOOD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-668-3600
Practice Address - Fax:530-668-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG433540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087050Medicaid
CAGR0087050Medicaid