Provider Demographics
NPI:1649215062
Name:PATRICK K GRIFFITH MD PC
Entity Type:Organization
Organization Name:PATRICK K GRIFFITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-743-5125
Mailing Address - Street 1:401 I ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5626
Mailing Address - Country:US
Mailing Address - Phone:530-743-5125
Mailing Address - Fax:530-743-4528
Practice Address - Street 1:401 I ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5626
Practice Address - Country:US
Practice Address - Phone:530-743-5125
Practice Address - Fax:530-743-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51011208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101920Medicaid
CADD9923OtherRAILROAD MEDICARE
CADD9923OtherRAILROAD MEDICARE
CAZZZ27505ZMedicare PIN
CAE46345Medicare UPIN
CAGR0101920Medicaid