Provider Demographics
NPI:1790965143
Name:REDWOOD PODIATRY GROUP
Entity Type:Organization
Organization Name:REDWOOD PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLICHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-441-1112
Mailing Address - Street 1:3258 TIMBER FALL CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4888
Mailing Address - Country:US
Mailing Address - Phone:707-441-1112
Mailing Address - Fax:707-441-1711
Practice Address - Street 1:3258 TIMBER FALL CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4888
Practice Address - Country:US
Practice Address - Phone:707-441-1112
Practice Address - Fax:707-441-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4285530001Medicare NSC