Provider Demographics
NPI:1942963442
Name:NIGHTWATER HEALTH OF CALIFORNIA APMC
Entity Type:Organization
Organization Name:NIGHTWATER HEALTH OF CALIFORNIA APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-500-8086
Mailing Address - Street 1:111 WATER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2456
Mailing Address - Country:US
Mailing Address - Phone:603-247-5442
Mailing Address - Fax:
Practice Address - Street 1:87 SCRIPPS DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6379
Practice Address - Country:US
Practice Address - Phone:916-415-7010
Practice Address - Fax:916-244-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC159092OtherMBC