| Anderson Valley Health Center | |
|
13500 Airport Road Boonville CA 95415 | |
| (707) 895-3477 | |
| (707) 895-2035 |
| Full Name | Anderson Valley Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 13500 Airport Road, Boonville, California |
| Authorized Official Name and Position | Susan D Smith (CEO) |
| Authorized Official Contact | 7078953477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anderson Valley Health Center Po Box 338 Boonville CA 95415-0338 Ph: (707) 895-3477 | Anderson Valley Health Center 13500 Airport Road Boonville CA 95415 Ph: (707) 895-3477 |
| NPI Number | 1568449304 |
|---|---|
| Provider Enumeration Date | 12/22/2005 |
| Last Update Date | 07/25/2015 |
| Medicare PECOS PAC ID | 4789628272 |
|---|---|
| Medicare Enrollment ID | O20090718000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568449304 | NPI | - | NPPES |
| 051024 | Medicaid | CA | |
| FHC03881F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000165 (California) | Primary |
| Provider Name | Mark J Apfel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538219779 PECOS PAC ID: 9830242643 Enrollment ID: I20090727000482 |
| Provider Name | Luiza Savin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982123170 PECOS PAC ID: 5395086193 Enrollment ID: I20190404000557 |