Provider Demographics
NPI:1851448039
Name:NAPA VALLEY UROLOGY ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NAPA VALLEY UROLOGY ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-224-7944
Mailing Address - Street 1:3250 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3406
Mailing Address - Country:US
Mailing Address - Phone:707-224-7944
Mailing Address - Fax:707-224-5220
Practice Address - Street 1:3250 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3406
Practice Address - Country:US
Practice Address - Phone:707-224-7944
Practice Address - Fax:707-224-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0315750001OtherDMERC
CA0315750001Medicare NSC
CAZZZ71285ZMedicare PIN