Provider Demographics
NPI:1598892622
Name:NAPA VALLEY FAMILY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:NAPA VALLEY FAMILY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-259-2000
Mailing Address - Street 1:1561 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2892
Mailing Address - Country:US
Mailing Address - Phone:707-259-2000
Mailing Address - Fax:707-259-0181
Practice Address - Street 1:1561 THIRD ST STE G
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2861
Practice Address - Country:US
Practice Address - Phone:707-259-2000
Practice Address - Fax:707-259-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAG51188207Q00000X
CAG38470207Q00000X
CAG5622207Q00000X
CAG30399207Q00000X
CAG32088207Q00000X
CAA43495207Q00000X
CAA79082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0599698OtherCLIA - 1001 PROFESSIONAL
CAA43495OtherMED LIC - DERMODY
CAG30399OtherMED LIC - MUELLER
CAG32088OtherMED LIC - REID
CAG38470OtherMED LIC - BROWN
CAG51188OtherMED LIC - SUARD
CA05D1602014OtherCLIA - 935 TRANCAS 1C
CA05D0599775OtherCLIA - 1155 TRANCAS
CA05D0600479OtherCLIA - ST HELENA
CAA79082OtherMED LIC - JEWELL
CAG8622OtherMED LIC - DARTER
CAA43495OtherMED LIC - DERMODY
CAA44998Medicare UPIN
CAG51188OtherMED LIC - SUARD
CAG38470OtherMED LIC - BROWN
CAA44409Medicare UPIN
CAA74792Medicare UPIN
CAA51926Medicare UPIN
CAG8622OtherMED LIC - DARTER