Eel River Valley Surgical Group
Organization Active NPI Surgery Physician · Fortuna, CA
NPI 1033262381 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1033262381
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- EEL RIVER VALLEY SURGICAL GROUP
- Practice address
- 3301 Renner Dr
Fortuna, CA 95540-3119 - Phone
- (707) 725-9301
- Fax
- (707) 725-6099
- NPI assigned
- Jan 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. John T Hassapis, MD
- Title
- Ceo
- Phone
- (707) 725-9301
Practitioners 3
-
Cassandra Ann Kennedy, M.D.
National Provider Directory
Locations
3301 Renner Dr
Fortuna, CA 95540
Phone (707) 725-9301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
3301 Renner Dr
Fortuna, CA 95540-3119
Mailing address
3301 Renner Dr
Fortuna, CA 95540-3119
Phone (707) 725-9301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0082870 | Medicaid | CA | |
| ZZZ56802Z | Other | CA | BLUE SHIELD GROUP ID |
Other names
- Eel River Valley Surgical Group
Other providers in Fortuna, CA
- Stephanie S Dittmer
- Mary Terese Dodd
- Tamara Smith Douglass
- Fannette Downie-Allman
- Clare Edwards
- Kelly Ehrhardt
- Kerisa Sue Elloway
- Courtney Embry
- Gabriel Enriquez
- Dana Louise Estevo
All providers in Fortuna, CA · Surgery Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.