Provider Demographics
NPI:1821233974
Name:KIMBERLY R FAUCHER MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KIMBERLY R FAUCHER MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-456-1100
Mailing Address - Street 1:415 TALMAGE ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-7486
Mailing Address - Country:US
Mailing Address - Phone:707-468-0609
Mailing Address - Fax:707-468-0633
Practice Address - Street 1:1155 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4336
Practice Address - Country:US
Practice Address - Phone:707-456-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74987207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG78220Medicare UPIN