Provider Demographics
NPI:1922138999
Name:UROLOGY ASSOCIATES OF THE HUMBOLDT NATION, AMC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF THE HUMBOLDT NATION, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALBERTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-445-3257
Mailing Address - Street 1:2576 RENFREW ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3345
Mailing Address - Country:US
Mailing Address - Phone:707-445-3257
Mailing Address - Fax:707-445-1027
Practice Address - Street 1:2576 RENFREW ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3345
Practice Address - Country:US
Practice Address - Phone:707-445-3257
Practice Address - Fax:707-445-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0000210Medicaid
CA02708930001OtherNORIDIAN DMERC
CAGR0000210Medicaid