| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 874 Main St, Fortuna, California |
| Authorized Official Name and Position | George A Jutila (VICE PRESIDENT) |
| Authorized Official Contact | 7077253334 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
874 Main St Fortuna CA 95540-1926 Ph: (707) 725-3334 | 874 Main St Fortuna CA 95540-1926 Ph: (707) 725-3334 |
| NPI Number | 1376655217 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 09/26/2007 |
| Medicare PECOS PAC ID | 5597754556 |
|---|---|
| Medicare Enrollment ID | O20040506001188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376655217 | NPI | - | NPPES |
| GR0021870 | Medicaid | CA | |
| RHM03936F | Other | RURAL HEALTH MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ruben E Brinckhaus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891708806 PECOS PAC ID: 8224027297 Enrollment ID: I20040506001742 |
| Provider Name | Barbara F Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760546626 PECOS PAC ID: 0547206591 Enrollment ID: I20050630000235 |
| Provider Name | Roxane K Heiob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164834578 PECOS PAC ID: 3577887439 Enrollment ID: I20150123001883 |
Ikigai Physician Group Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3429 Renner Dr, Fortuna, CA 95540 Phone: 707-726-2255 Fax: 707-949-9715 | |
Ikigai Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3429 Renner Dr, Fortuna, CA 95540 Phone: 707-726-2255 Fax: 707-949-9715 | |
Ikigai Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3429 Renner Dr, Fortuna, CA 95540 Phone: 707-726-2255 Fax: 707-949-9715 | |
Redwoods Rural Health Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 930 S Fortuna Blvd, Fortuna, CA 95540 Phone: 707-353-2162 | |
Fortuna Family Medicine Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2404 Newburg Rd, Fortuna, CA 95540 Phone: 707-617-2002 Fax: 833-941-4882 |