Provider Demographics
NPI:1013050814
Name:RECOVERY ROAD MEDICAL CENTER
Entity Type:Organization
Organization Name:RECOVERY ROAD MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-246-9585
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-3770
Mailing Address - Country:US
Mailing Address - Phone:805-962-7800
Mailing Address - Fax:805-962-9002
Practice Address - Street 1:1602 STATE STREET
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2520
Practice Address - Country:US
Practice Address - Phone:805-962-7800
Practice Address - Fax:805-962-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959161208D00000X
CA420034AP261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA82909Medicare ID - Type UnspecifiedLEGACY
CAH05496Medicare UPIN