| Dignity Health Medical Group - Dominican, A Service Of Dignity Health | |
|
13350 Big Basin Way Boulder Creek CA 95006-9237 | |
| (831) 338-2767 | |
| (831) 338-2767 |
| Full Name | Dignity Health Medical Group - Dominican, A Service Of Dignity Health |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 13350 Big Basin Way, Boulder Creek, California |
| Authorized Official Name and Position | Theresa M Hylen (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9168512559 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dignity Health Medical Group - Dominican, A Service Of Dignity Health 3160 Folsom Blvd Sacramento CA 95816-5219 Ph: (916) 733-5701 | Dignity Health Medical Group - Dominican, A Service Of Dignity Health 13350 Big Basin Way Boulder Creek CA 95006-9237 Ph: (831) 338-2767 |
| NPI Number | 1699971333 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 11/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699971333 | NPI | - | NPPES |
| GR0091683 | Medicaid | CA | |
| ZZZ50290Z | Other | BSCA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Western Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13350 Big Basin Way, Boulder Creek, CA 95006 Phone: 831-338-6491 Fax: 831-338-2767 |