MARIN COMMUNITY CLINIC (NPI# 1912091018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912091018 |
| Entity Type | Organization |
| Organization Name | MARIN COMMUNITY CLINIC |
| Practice Address |
5 Bon Air Rd Larkspur CA 94939-1143 |
| Mailing Address |
9 Commercial Blvd Suite 103 Novato CA 94949-6118 |
| Practice Telephone | 4154481500 |
| Practice Fax Number | 4154617334 |
| Mailing Telephone | 4154481500 |
| Mailing Fax Number | 4157983180 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-01-06 |
| Authorized Official Name | MS. DEBORAH UDALL (DIRECTOR OF PATIENT ACCOUNTS) |
| Authorized Official Telephone | 4157983106 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
110000366 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC11975 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780292912 | Marin Community Clinic | Clinic/Center | 1260 S Eliseo Dr Ste 201, Greenbrae, CA 94904-2009 | 2020-07-14 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1790788107 | Marin Community Clinic | Clinic/Center | 400 Professional Center Dr, Ste 424, Novato, CA 94947-4368 | 2005-05-31 |
| 1124021738 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2005-05-27 |
| 1881057115 | Marin Community Clinic | Clinic/Center | 6090 Redwood Blvd, Novato, CA 94945-4569 | 2016-04-04 |
| 1922303437 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2011-01-13 |
| 1912220781 | Marin Community Clinic | Clinic/Center | 6090 Redwood Blvd, Suite D, Novato, CA 94945-4569 | 2010-03-09 |
| 1154503399 | Marin Community Clinic | Clinic/Center | 3110 Kerner Blvd, San Rafael, CA 94901-5411 | 2007-11-29 |
| 1932327343 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
| 1669690079 | Marin Community Clinic | Clinic/Center | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2007-04-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MARIN COMMUNITY CLINICS | 9 Commercial Blvd Ste 100, Novato, CA 94949-6137 |
| Street Address |
5 BON AIR RD |
| City | LARKSPUR |
| State | CA |
| Zip Code | 94939-1143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679562649 | Karen Nugent | Specialist | 5 Bon Air Rd, Suite A105, Larkspur, CA 94939-1143 | 2005-10-20 |
| 1316473903 | Neurology Health Center, Incorporated | Psychiatry & Neurology | 5 Bon Air Rd, Building D, Suite 219, Larkspur, CA 94939-1143 | 2017-05-03 |
| 1760852503 | Marin Womens Health | Obstetrics & Gynecology | 5 Bon Air Rd, Bld D, Suite 219, Larkspur, CA 94939-1136 | 2015-10-06 |
| 1033512330 | John Eugene Conte Jr. | Internal Medicine | 5 Bon Air Rd, Larkspur, CA 94939-1143 | 2014-09-30 |
| 1477974483 | Nicholas Verville | Physical Therapist | 5 Bon Air Rd, Suite 129, Larkspur, CA 94939-1143 | 2013-12-17 |
| 1790106714 | Lindsey Kuroda | Physical Therapist | 5 Bon Air Rd, Suite A105, Larkspur, CA 94939-1143 | 2013-12-17 |
| 1770927204 | Stewart Lin | Physical Therapist | 5 Bon Air Rd, Suite 129, Larkspur, CA 94939-1143 | 2013-04-26 |
| 1851636617 | Anne White | Acupuncturist | 5 Bon Air Rd, Ste. 221, Larkspur, CA 94939-1143 | 2012-12-05 |
| 1558615963 | Laura Winner | Physical Therapist | 5 Bon Air Rd, Suite 129, Larkspur, CA 94939-1143 | 2012-11-07 |
| 1396026399 | Prima Medical Foundation | Surgery | 5 Bon Air Rd, #117, Larkspur, CA 94939-1143 | 2011-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760771901 | Benjamin Stahl | Surgery | Prima Medical Group, 5 Bon Air Road, #101, Larkspur, CA 94939 | 2011-03-28 |
| 1215100383 | Richard William Brenner | Psychiatry & Neurology | 980 Magnolia Ave, Ste 8, Larkspur, CA 94939 | 2008-04-09 |
| 1053584680 | Todd A Maderis | Acupuncturist | 1100 Larkspur Landing Cir #255, Larkspur, CA 94939 | 2008-04-03 |
| 1073709416 | Arundathi Shenoy Malladi | Internal Medicine | 2 Bon Air Rd., #150, Larkspur, CA 94939 | 2007-09-19 |
| 1386855567 | Katherine Louise Chick | Internal Medicine | 980 Magnolia Avenue, Suite 6a, Larkspur, CA 94939 | 2007-05-27 |
| 1639215148 | David W Rose | Chiropractor | 641 Magnolia Ave, #1, Larkspur, CA 94939 | 2007-01-30 |
| 1205988623 | Jay R Salzman | Dentist | 2200 Larkspur Landing Circle, Larkspur, CA 94939 | 2007-01-17 |
| 1497782585 | Katherine Manning | Physical Therapist | 2801larkspur Landing Circle, Larkspur, CA 94939 | 2006-06-26 |
| 1720067226 | Jan Ellen Maisel | Pediatrics | 5 Bon Air Road, Ste. 105, Larkspur, CA 94939 | 2006-01-12 |
| 1740267715 | Jacqueline Susanna Chan | Family Medicine | 1100 Larkspur Landing Circle #255, Larkspur, CA 94939 | 2005-12-29 |
| Find all providers in zip 94939 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.