Provider Demographics
NPI:1215023056
Name:REDWOOD ORTHOPAEDIC SURGERY ASSOCIATES AMC
Entity type:Organization
Organization Name:REDWOOD ORTHOPAEDIC SURGERY ASSOCIATES AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:707-755-5405
Mailing Address - Street 1:208 CONCOURSE BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:707-544-3400
Practice Address - Street 1:208 CONCOURSE BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0046620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6611980001Medicare NSC
CAZZZ23153ZMedicare PIN