PETALUMA HEALTH CENTER INC NPI 1760584049

NPI Information

NPI: 1760584049
Provider Name: PETALUMA HEALTH CENTER INC

Doing Business As: BOLINAS FAMILY PRACTICE

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
88 MESA RD
BOLINAS, CA
ZIP 94924
Phone: (415) 868-0124
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PETALUMA HEALTH CENTER INC is a federally qualified health center (fqhc) clinic center in Bolinas, CA. PETALUMA HEALTH CENTER INC NPI is 1760584049. The provider is registered as an organization entity type.
The provider Is Doing Business As Bolinas Family Practice.

The provider's business location address is:

88 MESA RD
BOLINAS, CA
ZIP 94924-713
Phone: (415) 868-0124
Fax: (415) 868-2152

The provider's authorized official is Molly Jouaneh .
The authorized official title is Cfo and has the following contact phone number (707) 559-7500.

The CLIA number assigned to this NPI record is 05D0605063 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 9/5/2006 and was last updated on 6/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	110000397	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	FHC03885G	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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