| Round Valley Indian Health Center, Inc. | |
|
24065 Biggar Lane Covelo CA 95428-0247 | |
| (707) 983-6404 | |
| (707) 983-6184 |
| Full Name | Round Valley Indian Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 24065 Biggar Lane, Covelo, California |
| Authorized Official Name and Position | Otis D Brotherton (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7079836181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Round Valley Indian Health Center, Inc. Po Box 247 Covelo CA 95428-0247 Ph: (707) 983-6404 | Round Valley Indian Health Center, Inc. 24065 Biggar Lane Covelo CA 95428-0247 Ph: (707) 983-6404 |
| NPI Number | 1669532750 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 03/14/2024 |
| Medicare PECOS PAC ID | 9234128927 |
|---|---|
| Medicare Enrollment ID | O20040507001316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669532750 | NPI | - | NPPES |
| THP11697F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 110000097 (California) | Primary |
| Provider Name | Steven Philip Johannsen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1518041912 PECOS PAC ID: 6305805292 Enrollment ID: I20041006001089 |
| Provider Name | Laurence R Alavezos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306067327 PECOS PAC ID: 6204862790 Enrollment ID: I20050715000669 |
| Provider Name | Marvin G Trotter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720027436 PECOS PAC ID: 8123105608 Enrollment ID: I20080408000613 |
| Provider Name | Cheri L Heffel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508833153 PECOS PAC ID: 7719014414 Enrollment ID: I20100429000486 |
| Provider Name | James Shubin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295723518 PECOS PAC ID: 0345370029 Enrollment ID: I20100607000102 |
| Provider Name | Kevin J Mack |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760416903 PECOS PAC ID: 2769674233 Enrollment ID: I20101004000418 |
| Provider Name | Marilyn S Magoffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659562742 PECOS PAC ID: 8123280385 Enrollment ID: I20120504000039 |
| Provider Name | Samuel Martisius |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043440308 PECOS PAC ID: 1052559762 Enrollment ID: I20130607000091 |
| Provider Name | Snehal J Raisoni |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1487973798 PECOS PAC ID: 8820387533 Enrollment ID: I20160519001836 |
| Provider Name | Emily J Bruton |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750749495 PECOS PAC ID: 4587959077 Enrollment ID: I20160823001783 |
| Provider Name | Luis G Maduro |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881813079 PECOS PAC ID: 0042504151 Enrollment ID: I20170522001241 |
| Provider Name | Jodi L Parungao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932528965 PECOS PAC ID: 1355560954 Enrollment ID: I20181016003217 |
| Provider Name | Travis Lee Brakeman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205392925 PECOS PAC ID: 8527499607 Enrollment ID: I20200505000308 |
| Provider Name | David Applegate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629196571 PECOS PAC ID: 4981775905 Enrollment ID: I20221109000680 |
| Provider Name | Shardale Mcafee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891226346 PECOS PAC ID: 5395091193 Enrollment ID: I20230518001317 |
| Provider Name | Rockzine Ngwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609305432 PECOS PAC ID: 8729346960 Enrollment ID: I20240513001838 |
| Provider Name | Ocean H. Hu |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467457333 PECOS PAC ID: 8729518170 Enrollment ID: I20250213003738 |
| Provider Name | Jessica I Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265848121 PECOS PAC ID: 3971874827 Enrollment ID: I20250520004373 |