Alpine Creek and Pine Valley Family Medicine Inc.
Organization Active NPI Neuromusculoskeletal Medicine & OMM Physician · Alpine, CA
NPI 1295819639 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295819639
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician 204D00000X
- License
- 20A4384 (CA)
- Legal business name
- ALPINE CREEK AND PINE VALLEY FAMILY MEDICINE INC.
- Practice address
- 1347 Tavern Rd Ste 9
Alpine, CA 91901-3897 - Phone
- (619) 445-0205
- Fax
- (619) 659-0205
- NPI assigned
- Oct 24, 2006
- Organization subpart
- No
Authorized official
- Name
- James M Ricketts, D.O.
- Title
- Ceo
- Phone
- (619) 445-0204
Practitioners 1
-
Donald S Adema, DO
National Provider Directory
Locations
1347 Tavern Rd
Ste 9
Alpine, CA 91901
Phone (619) 445-0204
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician |
204D00000X | 20A4384 | CA | Yes |
Addresses
Primary practice location
1347 Tavern Rd Ste 9
Alpine, CA 91901-3897
Mailing address
1347 Tavern Rd Ste 9
Alpine, CA 91901-3897
Phone (619) 445-0205
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ48102Z | Other | CA | BLUE SHIELD |
| 00AX43840 | Medicaid | CA | |
| 00AX62390 | Medicaid | CA |
Other providers in Alpine, CA
- Alisha Faye Akers
- Albertsons LLC
- Daphanie Martina Allen
- Nicole Allison
- Kristin Allred
- Alpine Dentistry
- Alpine Physical Therapy & Wellness Center, Inc
- Alpine Special Treatment Center
- Alpine Special Treatment Center
- Alpine Special Treatment Center
All providers in Alpine, CA · Neuromusculoskeletal Medicine & OMM 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.