Provider Demographics
NPI:1386731693
Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:REDWOOD REGIONAL MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-253-7161
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 256
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2908
Mailing Address - Country:US
Mailing Address - Phone:707-253-7161
Mailing Address - Fax:707-253-0476
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 256
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-253-7161
Practice Address - Fax:707-253-0476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOOD REGIONAL MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0000X, 207RH0003X, 207RX0202X
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0049203Medicaid
ZZZ00533ZMedicare ID - Type Unspecified