| Providence Family Practice | |
|
3302 Renner Dr Fortuna CA 95540 | |
| (707) 725-3318 | |
| Not Available |
| Full Name | Providence Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 3302 Renner Dr, Fortuna, California |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Practice 3300 Renner Dr Fortuna CA 95540-3120 Ph: (707) 269-4263 | Providence Family Practice 3302 Renner Dr Fortuna CA 95540 Ph: (707) 725-3318 |
| NPI Number | 1194189654 |
|---|---|
| Provider Enumeration Date | 04/11/2016 |
| Last Update Date | 07/14/2021 |
| Medicare PECOS PAC ID | 8921374562 |
|---|---|
| Medicare Enrollment ID | O20180322002714 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194189654 | NPI | - | NPPES |
| 1194189654 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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 Medical Group Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 874 Main St, Fortuna, CA 95540 Phone: 707-725-3334 Fax: 707-725-2455 | |
Fortuna Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2404 Newburg Rd, Fortuna, CA 95540 Phone: 707-725-3334 Fax: 707-725-2455 |