Provider Demographics
NPI:1871683458
Name:NORTH COAST ORTHOPAEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:NORTH COAST ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-826-7870
Mailing Address - Street 1:4779 VALLEY EAST BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4631
Mailing Address - Country:US
Mailing Address - Phone:707-826-7870
Mailing Address - Fax:707-826-7869
Practice Address - Street 1:4779 VALLEY EAST BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4631
Practice Address - Country:US
Practice Address - Phone:707-826-7870
Practice Address - Fax:707-826-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9669207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2276402Medicaid
CA2276402Medicaid
CAH67973Medicare UPIN