1245582303 NPI number — COUNTY OF BUTTE

Table of content: DUKE WADE HARTWELL PT (NPI 1124066485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245582303 NPI number — COUNTY OF BUTTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF BUTTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245582303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 PARMAC RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-2294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-891-2980
Provider Business Mailing Address Fax Number:
530-895-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
586 RIO LINDO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-2945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILNER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT DIRECTOR
Authorized Official Telephone Number:
530-891-2980

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)