Provider Demographics
NPI:1548345416
Name:DOWNTOWN MEDICAL CLINIC INC.
Entity type:Organization
Organization Name:DOWNTOWN MEDICAL CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAASHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-2293
Mailing Address - Street 1:2505 LUCAS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3340
Mailing Address - Country:US
Mailing Address - Phone:707-443-2293
Mailing Address - Fax:707-443-1338
Practice Address - Street 1:2505 LUCAS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3340
Practice Address - Country:US
Practice Address - Phone:707-443-2293
Practice Address - Fax:707-443-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM53963F261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53963Medicaid
CARHM53963Medicaid
CA=========OtherTAX ID
CA553963Medicare Oscar/Certification