Provider Demographics
NPI:1013073782
Name:EEL VALLEY RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:EEL VALLEY RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:BENSELL
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-764-3139
Mailing Address - Street 1:129E WILDWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:RIO DELL
Mailing Address - State:CA
Mailing Address - Zip Code:95562-1723
Mailing Address - Country:US
Mailing Address - Phone:707-764-3139
Mailing Address - Fax:707-269-9074
Practice Address - Street 1:129E WILDWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:RIO DELL
Practice Address - State:CA
Practice Address - Zip Code:95562-1723
Practice Address - Country:US
Practice Address - Phone:707-764-3139
Practice Address - Fax:707-269-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health