LIVE OAK MEDICAL CLINIC
NPI 1316096894
Clinic/Center - Federally Qualified Health Center (FQHC) in Live Oak, CA

Q: What is Peach Tree Healthcare's NPI number?

The NPI number for Peach Tree Healthcare is 1316096894. It was assigned to this organization in the NPPES registry on January 10, 2007. The provider is doing business as Live Oak Medical Clinic.

Q: What is Peach Tree Healthcare's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since January 10, 2007CLIA 05D0892413 · Waiver

9980 LIVE OAK BLVD, LIVE OAK, CA 95953(530) 749-3242(530) 749-3248 Get Directions Write a Review

NPPES record last updated: May 23, 2022. Verified against the NPPES registry weekly; last sync: September 20, 2026.

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About Live Oak Medical Clinic NPPES

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

LIVE OAK MEDICAL CLINIC (NPI 1316096894) is a healthcare organization registered as a federally qualified health center (fqhc) in Live Oak, California and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through September 28, 2028 and lists Greg Stone, Ceo, as its authorized official.

NPPES Registry Identity

NPI1316096894

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NamePEACH TREE HEALTHCARE

Location Address9980 LIVE OAK BLVDLive Oak, CA 95953-2334

Mailing Address1114 Yuba St Ste 220Marysville, CA 95901-4838 · (530) 749-3242 · Fax (530) 749-3248

Phone(530) 749-3242

Fax(530) 749-3248

Organization SubpartNo

Authorized OfficialGreg StoneCeo · (530) 741-6245

Enumeration DateJanuary 10, 2007

Last NPPES UpdateMay 23, 2022

NPPES CertifiedMay 23, 2022

✔ NPI 1316096894 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

License✔ Licensed in CA · 550000248

Also ListedOptometristTaxonomy 152W00000X · License 14503TLG (CA)

Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X

Also ListedFamily MedicineTaxonomy 207Q00000X · License C51576 (CA)

Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License A93985 (CA)

9980 LIVE OAK BLVD, Live Oak, CA 95953

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Other Names 1

Doing Business AsLive Oak Medical Clinic

Other Identifiers 1

MedicaidFHC71147FCA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0892413

Peach Tree Clinic Dba Live Oak Medical Clinic · Live Oak, CA

Active · expires Sep 28, 2028

CLIA Number05D0892413

Laboratory TypeCommunity Clinic

Certificate Effective DateSeptember 29, 2026

Certificate Expiration DateSeptember 28, 2028

Laboratory DirectorMary Rosalie Pena-Pridmore

Laboratory Phone(530) 749-3242

Laboratory LocationPeach Tree Clinic Dba Live Oak Medical Clinic9980 Live Oak Blvd, Live Oak, CA 95953

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

ANDREA BONNENFANT

Physician Assistant

9980 LIVE OAK BLVD
LIVE OAK, CA 95953

Sutter County (530) 695-0700

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 Peach Tree Healthcare's NPI number?

The NPI number for Peach Tree Healthcare is 1316096894. It was assigned to this organization in the NPPES registry on January 10, 2007. The provider is doing business as Live Oak Medical Clinic.

Where is Peach Tree Healthcare located?

Peach Tree Healthcare is located at 9980 Live Oak Blvd, Live Oak, CA 95953. The listed phone number is (530) 749-3242.

What is Peach Tree Healthcare's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Peach Tree Healthcare hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0892413) is associated with this NPI, valid through September 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Peach Tree Healthcare was last updated on May 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.