| Redwood Coast Medical Services, Inc. | |
|
46900 Ocean Dr Gualala CA 95445-8353 | |
| (707) 884-4005 | |
| (707) 884-9728 |
| Full Name | Redwood Coast Medical Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 46900 Ocean Dr, Gualala, California |
| Authorized Official Name and Position | Diane Agee (CEO) |
| Authorized Official Contact | 7078849476 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redwood Coast Medical Services, Inc. Po Box 1100 Gualala CA 95445-1100 Ph: (707) 884-4005 | Redwood Coast Medical Services, Inc. 46900 Ocean Dr Gualala CA 95445-8353 Ph: (707) 884-4005 |
| NPI Number | 1962530725 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 12/24/2013 |
| Medicare PECOS PAC ID | 6901941905 |
|---|---|
| Medicare Enrollment ID | O20100302000446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962530725 | NPI | - | NPPES |
| FHC03906F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000048 (California) | Primary |
| Provider Name | Mark P Kal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316937931 PECOS PAC ID: 2668487182 Enrollment ID: I20060220000403 |
| Provider Name | Sona A Weber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932320850 PECOS PAC ID: 1658424957 Enrollment ID: I20090804000675 |
| Provider Name | Thomas A Bertolli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811089717 PECOS PAC ID: 4385799568 Enrollment ID: I20090911000627 |
| Provider Name | Peter Arellano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295814325 PECOS PAC ID: 0648467456 Enrollment ID: I20101206001022 |
| Provider Name | Katherine Willems |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134393069 PECOS PAC ID: 4486895042 Enrollment ID: I20130724000106 |
| Provider Name | Lois R Falk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346332335 PECOS PAC ID: 7618192204 Enrollment ID: I20140716000775 |
| Provider Name | Andrew Steiger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376639740 PECOS PAC ID: 2668469735 Enrollment ID: I20161201000841 |
| Provider Name | Afsoon Foorohar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962897645 PECOS PAC ID: 3274871298 Enrollment ID: I20190215002079 |
| Provider Name | Clement B Binnings |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760457162 PECOS PAC ID: 6103986401 Enrollment ID: I20190328001534 |
| Provider Name | Holly R Hamm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285416123 PECOS PAC ID: 5799138871 Enrollment ID: I20240124004109 |
| Provider Name | Olaf K Golubjatnikov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336900968 PECOS PAC ID: 4486009420 Enrollment ID: I20240918003959 |
| Provider Name | Stacey P Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396207049 PECOS PAC ID: 0941633911 Enrollment ID: I20250408003942 |
| Provider Name | Molly J Behrens |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1881203602 PECOS PAC ID: 2264956200 Enrollment ID: I20250410003123 |
| Provider Name | Pamela A Tait |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1639408438 PECOS PAC ID: 6406371889 Enrollment ID: I20250417002802 |