| Angela I Ingendaay M D Professional Corporation | |
|
150 S Auburn St Grass Valley CA 95945-6576 | |
| (530) 559-1342 | |
| (530) 692-7020 |
| Full Name | Angela I Ingendaay M D Professional Corporation |
|---|---|
| Speciality | General Practice |
| Location | 150 S Auburn St, Grass Valley, California |
| Authorized Official Name and Position | Angela I Ingendaay (CEO/MD) |
| Authorized Official Contact | 5305591342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela I Ingendaay M D Professional Corporation Po Box 856 Oregon House CA 95962-0856 Ph: (530) 559-1342 | Angela I Ingendaay M D Professional Corporation 150 S Auburn St Grass Valley CA 95945-6576 Ph: (530) 559-1342 |
| NPI Number | 1770188252 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 02/17/2021 |
| Medicare PECOS PAC ID | 3971910183 |
|---|---|
| Medicare Enrollment ID | O20210405001452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770188252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Angela I Ingendaay |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1952461295 PECOS PAC ID: 4981782281 Enrollment ID: I20080428000460 |
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