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PROVIDENCE MEDICAL FOUNDATION
NPI 1477790517
Surgery in Eureka, CA

Active since January 12, 2009CLIA 05D2284084 · Waiver
2752 HARRISON AVE, SUITE A, EUREKA, CA 95501(707) 268-0190 Get Directions Write a Review

NPPES record last updated: February 3, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 3, 2026, May 5, 2021, Sep 11, 2017 (3 updates tracked since 2017).

About Providence Medical Foundation NPPES

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

PROVIDENCE MEDICAL FOUNDATION (NPI 1477790517), doing business as St Joseph Heritage Healthcare, is a healthcare organization registered as a surgery in Eureka, California and active in the NPI registry since January 2009. The organization holds a CLIA Waiver certificate valid through June 15, 2027 and lists Donald W. Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1477790517
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NamePROVIDENCE MEDICAL FOUNDATION
Location Address2752 HARRISON AVE, SUITE AEureka, CA 95501-4738
Mailing AddressPo Box 31001 - 1920Pasadena, CA 91110-1920 · (714) 449-4800 · Fax (714) 449-4956
Phone(707) 268-0190
Organization SubpartNo
Authorized OfficialDonald W. AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateJanuary 12, 2009
Last NPPES UpdateFebruary 3, 20263 updates tracked since enumeration
NPPES CertifiedFebruary 3, 2026
✔ NPI 1477790517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
2752 HARRISON AVE, Eureka, CA 95501
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Other Names 2

Former Legal Business NameSt Joseph Heritage Healthcare
Former Legal Business NameSt Jude Hospital Yorba Linda

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 05D2284084

Providence Medical Foundation Dba Providence Medical Group Pediatrics And Pregnancy Services · Eureka, CA
Active · expires Jun 15, 2027
CLIA Number05D2284084
Laboratory TypePhysician Office
Certificate Effective DateJune 16, 2025
Certificate Expiration DateJune 15, 2027
Laboratory DirectorWilliam Parks
Laboratory Phone(707) 444-6011
Laboratory LocationProvidence Medical Foundation Dba Providence Medical Group Pediatrics And Pregnancy Services2200 Harrison Ave Ste D, Eureka, CA 95501
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

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

DR. STEPHEN R DIEKER JR. MD
Anesthesiology
2752 HARRISON AVE, SUITE A
EUREKA, CA 95501
Humboldt County (707) 268-0190
MARK B PARDOE M.D.
Plastic Surgery
2752 HARRISON AVE, SUITE A
EUREKA, CA 95501
Humboldt County (707) 445-3075
JOHN ARYANPUR M.D.
Neurological Surgery
2752 HARRISON AVE, SUITE A
EUREKA, CA 95501
Humboldt County (707) 268-0190
NORTHCOAST NEUROSURGICAL ASSOCIATES A MEDICAL CORPORATION
Neurological Surgery
2752 HARRISON AVE, SUITE A
EUREKA, CA 95501
Humboldt County (707) 268-0190
DR. JON A OMEY DDS
Dentist (General Practice)
2752 HARRISON AVE, SUITE B
EUREKA, CA 95501
Humboldt County (707) 443-7877
RUSSEL PARDOE, M.D., INC.
Specialist
2752 HARRISON AVE, SUITE A
EUREKA, CA 95501
Humboldt County (707) 445-3075

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 Providence Medical Foundation's NPI number?

The NPI number for Providence Medical Foundation is 1477790517. It was assigned to this organization in the NPPES registry on January 12, 2009. The provider was formerly known as St Joseph Heritage Healthcare and St Jude Hospital Yorba Linda.

Where is Providence Medical Foundation located?

Providence Medical Foundation is located at 2752 Harrison Ave Suite A, Eureka, CA 95501. The listed phone number is (707) 268-0190.

What is Providence Medical Foundation's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Does Providence Medical Foundation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2284084) is associated with this NPI, valid through June 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Providence Medical Foundation was last updated on February 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.