ANDERSON VALLEY HEALTH CENTER; NPI #1568449304

Contact Information

ANDERSON VALLEY HEALTH CENTER

13500 AIRPORT ROAD
BOONVILLE, CA 95415

Phone: 707-895-3477
Fax: 707-895-2035
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center
Family Medicine	207Q00000X	08	Physician/Family Practice

Indicates primary specialty

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NPI Profile & details for ANDERSON VALLEY HEALTH CENTER

NPI # 1568449304

LBN Legal business name ANDERSON VALLEY HEALTH CENTER

Authorized official SUSAN SMITH - (CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 12/22/2005

Last updated 07/25/2015 - About 11 years ago

Identifiers

CA	License #	110000165
CA	Medicaid	051024
CA	Medicaid	FHC03881F

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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