| St. Joseph Health Northern California, Llc | |
|
3302 Renner Dr Fortuna CA 95540 | |
| (707) 725-3318 | |
| Not Available |
| Full Name | St. Joseph Health Northern California, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3302 Renner Dr, Fortuna, California |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Joseph Health Northern California, Llc Po Box 31001-3059 Pasadena CA 91110-3059 Ph: (707) 269-4263 | St. Joseph Health Northern California, Llc 3302 Renner Dr Fortuna CA 95540 Ph: (707) 725-3318 |
| NPI Number | 1194189654 |
|---|---|
| Provider Enumeration Date | 04/11/2016 |
| Last Update Date | 05/07/2025 |
| 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 |
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Philip L. Olkin, M.d. And C. Ray Jones, M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3302 Renner Dr, Fortuna, CA 95540 Phone: 707-725-3318 Fax: 707-725-9396 | |
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