Provider Demographics
NPI:1659468973
Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
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 1:347 ANDRIEUX ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6811
Mailing Address - Country:US
Mailing Address - Phone:707-935-5460
Mailing Address - Fax:707-935-5466
Practice Address - Street 1:347 ANDRIEUX ST STE 1
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6811
Practice Address - Country:US
Practice Address - Phone:707-935-5460
Practice Address - Fax:707-935-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058131Medicaid
CAGR0058131Medicaid