Provider Demographics
NPI:1750461570
Name:HUMBOLDT NEUROLOGICAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HUMBOLDT NEUROLOGICAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-443-9385
Mailing Address - Street 1:2828 ONEIL LANE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4870
Mailing Address - Country:US
Mailing Address - Phone:707-443-9385
Mailing Address - Fax:707-443-0258
Practice Address - Street 1:2828 ONEIL LANE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4870
Practice Address - Country:US
Practice Address - Phone:707-443-9385
Practice Address - Fax:707-443-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76652ZMedicaid
CACP2087OtherRAILROAD MEDICARE
CACP2087OtherRAILROAD MEDICARE