Provider Demographics
NPI:1881882173
Name:MINOR EVERETT WARD MD INC
Entity type:Organization
Organization Name:MINOR EVERETT WARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-265-2627
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-0206
Mailing Address - Country:US
Mailing Address - Phone:530-265-2627
Mailing Address - Fax:530-478-9827
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE J
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-272-2257
Practice Address - Fax:530-478-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23027208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G230270Medicaid
CACE358AOtherMEDICARE PTAN
CAA41818Medicare UPIN