Provider Demographics
NPI:1427272459
Name:COUNTY OF EL DORADO
Entity type:Organization
Organization Name:COUNTY OF EL DORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR - PUBLIC HEALTH DIV
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGEHEUER
Authorized Official - Suffix:
Authorized Official - Credentials:MN, RN, PHN
Authorized Official - Phone:530-621-6129
Mailing Address - Street 1:929 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4543
Mailing Address - Country:US
Mailing Address - Phone:530-621-6372
Mailing Address - Fax:530-295-2580
Practice Address - Street 1:931 SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4543
Practice Address - Country:US
Practice Address - Phone:530-621-6100
Practice Address - Fax:530-295-2501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF EL DORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11481FMedicaid
CAZZR11481FMedicaid