Konocti Emergency Physicians

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

KONOCTI EMERGENCY PHYSICIANS

Practice address

15630 18TH Ave
Clearlake, CA 95422-9336

Phone

(707) 994-6486

NPI assigned

Nov 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles T Mitchell, MD

Title

General Partner

Phone

(805) 563-3011

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1023263399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 STATE ST",
            "address_2": "#300",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931055602",
            "telephone_number": "805-563-3011",
            "fax_number": "805-564-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15630 18TH AVE",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229336",
            "telephone_number": "707-994-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KONOCTI EMERGENCY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-29",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "805-563-3011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "ZZZ55400Y",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Kinsel, DDS
• Grace Deanna Klang
• Aileen Elizabeth Klein, LCSW
• Leanne Michelle Klier
• Edward Kondrot, MD
• Thomas C Kreck, MD
• Judith Ann Krings
• Salena Lair
• Lake County Community Action Agency
• Lake County Community Action Agency

• Emergency Medicine Physician in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.