OrganizationActive
Mendo Lake Urologic Medical Group, Inc
NPI 1083646525 · Specialist · Ukiah, CA
Mendo Lake Urologic Medical Group, Inc is a Specialist organization in Ukiah, CA (NPI 1083646525).
Provider details
- NPI number
- 1083646525
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Robert Blackwelder, Owner(707) 462-1928
- License
- A24853 (CA)
Specialties & taxonomies
Other Service Providers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
246 Hospital Dr
Ukiah, CA 95482-4533
Phone: (707) 462-1928
Fax: (707) 462-8642
Street-level locationGet directions
Mailing address
246 Hospital Dr
Ukiah, CA 95482-4533
Other names (DBA / former)
- Doing business as
- Mendo Lake Urology
Registry dates
- Enumerated
- 2006-07-07
- Last updated
- 2007-07-18
Frequently asked questions
- What is Mendo Lake Urologic Medical Group, Inc's NPI number?
- Mendo Lake Urologic Medical Group, Inc's National Provider Identifier (NPI) is 1083646525, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mendo Lake Urologic Medical Group, Inc?
- Mendo Lake Urologic Medical Group, Inc is classified in the NPPES registry as Specialist (Other Service Providers).
- Where is Mendo Lake Urologic Medical Group, Inc located?
- Mendo Lake Urologic Medical Group, Inc's practice location on file with NPPES is 246 Hospital Dr, Ukiah, CA 95482-4533.
- What is Mendo Lake Urologic Medical Group, Inc's phone number?
- The practice phone number listed in the NPPES registry for Mendo Lake Urologic Medical Group, Inc is (707) 462-1928.
- Who is the authorized official for Mendo Lake Urologic Medical Group, Inc?
- The authorized official listed on Mendo Lake Urologic Medical Group, Inc's NPPES record is Robert Blackwelder, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mendo Lake Urologic Medical Group, Inc's NPI active?
- Yes — Mendo Lake Urologic Medical Group, Inc's NPI (1083646525) is active in the NPPES registry as of the last update on 2007-07-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.