Basic Information
| Provider Information | |||||||||
| NPI: | 1851448039 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAPA VALLEY UROLOGY ASSOCIATES A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 BEARD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072247944 | ||||||||
| FaxNumber: | 7072245220 | ||||||||
| Practice Location | |||||||||
| Address1: | 3250 BEARD RD | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072247944 | ||||||||
| FaxNumber: | 7072245220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | HENDRICKS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7072247944 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C38117 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0315750001 | 01 | DMERC | OTHER |