Northcoast Family Practice Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G62640 Issued in CA

Legal business name

NORTHCOAST FAMILY PRACTICE MEDICAL GROUP INC

Practice address

2505 Lucas St
Eureka, CA 95501-3340

Phone

(707) 445-3063

Fax

(707) 442-6602

NPI assigned

Sep 14, 2006

Organization subpart

No

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

Authorized official

Name

Anne E Tait, MD

Title

Ceo

Phone

(707) 445-3063

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eureka Allergy Clinic Doing business as

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730284696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 LUCAS ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013340",
            "telephone_number": "707-445-3063",
            "fax_number": "707-442-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 LUCAS ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013340",
            "telephone_number": "707-445-3063",
            "fax_number": "707-442-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHCOAST FAMILY PRACTICE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAIT",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-445-3063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G62640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G626400",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eureka Allergy Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Coast Family Counseling, Professional Corporation
• North Coast Ministries
• North Coast Oncology & Hematology a Medical Corporation
• North Coast Substance Abuse Council
• North Coast Surgical Specialists
• Northcoast Neurosurgical Associates a Medical Corporation
• Northern California Community Blood Bank
• Northern California Medical Assoc
• Northern United Charter Schools
• Laurel Northrop

• Family Medicine Physician in Eureka, CA
• Providers in Eureka, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.