Basic Information
| Provider Information | |||||||||
| NPI: | 1942709803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMBOLDT RADIOLOGY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6428 | ||||||||
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| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955026428 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 RENNER DR | ||||||||
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| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955403120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077253361 | ||||||||
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| ProviderEnumerationDate: | 02/06/2018 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | ALBRIGHT | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7074427814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.