Provider Demographics
NPI:1568525400
Name:JOHN R GLYER D MILLS MATHESON & MARGARET ARNER MDS PTR
Entity Type:Organization
Organization Name:JOHN R GLYER D MILLS MATHESON & MARGARET ARNER MDS PTR
Other - Org Name:BAECHTEL CREEK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MILLS
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-459-6861
Mailing Address - Street 1:1245 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4305
Mailing Address - Country:US
Mailing Address - Phone:707-459-6861
Mailing Address - Fax:707-459-3057
Practice Address - Street 1:1245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4305
Practice Address - Country:US
Practice Address - Phone:707-459-6861
Practice Address - Fax:707-459-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA053968261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA053968Medicare Oscar/Certification
CAZZZ78182ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #