1. Home
  2. Directory
  3. California
  4. Ukiah
  5. Specialist
  6. NPI Profile

MENDO LAKE UROLOGY
NPI 1083646525
Specialist in Ukiah, CA

Active since July 07, 2006
246 HOSPITAL DR, UKIAH, CA 95482(707) 462-1928(707) 462-8642 Get Directions Write a Review

NPPES record last updated: July 18, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mendo Lake Urology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MENDO LAKE UROLOGY (NPI 1083646525) is a healthcare organization registered as a specialist in Ukiah, California and active in the NPI registry since July 2006. The organization lists Robert Earl Blackwelder, Owner, as its authorized official.

NPPES Registry Identity

NPI1083646525
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMENDO LAKE UROLOGIC MEDICAL GROUP, INC
Location Address246 HOSPITAL DRUkiah, CA 95482-4533
Mailing Address246 Hospital DrUkiah, CA 95482-4533 · (707) 462-1928 · Fax (707) 462-8642
Phone(707) 462-1928
Fax(707) 462-8642
Organization SubpartNo
Authorized OfficialRobert Earl BlackwelderOwner · (707) 462-1928
Enumeration DateJuly 7, 2006
Last NPPES UpdateJuly 18, 2007
✔ NPI 1083646525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · A24853
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
246 HOSPITAL DR, Ukiah, CA 95482
Open in Google Maps ↗

Other Names 1

Doing Business AsMendo Lake Urology

Other Identifiers 6

Medicare ID-Type UnspecifiedZZZ99729ZCA · Fort Bragg Provider #
Medicare ID-Type UnspecifiedZZZ74887ZCA · Ukiah Provider #
Medicare UPINA24161CA
Medicare ID-Type UnspecifiedZZZ15652ZCA · Np Provider #
Medicare ID-Type UnspecifiedZZZ99532ZCA · Lakeport Provider #
MedicaidZZZ74887ZCA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ZIAD HANNA D.O.
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8000
DR. DANIEL OJALA DO
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8011
DR. RANDAL E SCHAFER MD
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8011
DR. ROBERT F. CROCHELT M.D., PHD., F.A.C.S.
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 462-8011
DR. FREDRICK ANTHONY BURRIS M.D.
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8000
DR. JOANNE LEIBE DO, MPH, FACS
Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8011
MRS. SHANNON CROSS TODD FNP
Nurse Practitioner (Family)
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8011
DR. WILLIAM FORREST CRESS M.D.
Orthopaedic Surgery
246 HOSPITAL DR
UKIAH, CA 95482
Mendocino County (707) 463-8011

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mendo Lake Urologic Medical Group, Inc's NPI number?

The NPI number for Mendo Lake Urologic Medical Group, Inc is 1083646525. It was assigned to this organization in the NPPES registry on July 7, 2006. The provider is doing business as Mendo Lake Urology.

Where is Mendo Lake Urologic Medical Group, Inc located?

Mendo Lake Urologic Medical Group, Inc is located at 246 Hospital Dr, Ukiah, CA 95482. The listed phone number is (707) 462-1928.

What is Mendo Lake Urologic Medical Group, Inc's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Mendo Lake Urologic Medical Group, Inc was last updated on July 18, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.