1336580422 NPI number — ENLOE MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336580422 NPI number — ENLOE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENLOE MEDICAL CENTER
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:
ENLOE NEUROSURGICAL & SPINE CLINIC
Provider Other Organization Name Type Code:
3
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:
1336580422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1531 ESPLANADE
Provider Second Line Business Mailing Address:
ATTN: FINANCE
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-332-7300
Provider Business Mailing Address Fax Number:
530-893-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 COHASSET RD
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-2241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-895-3333
Provider Business Practice Location Address Fax Number:
530-895-3217
Provider Enumeration Date:
07/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MACHULA
Authorized Official First Name:
MYRON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
530-332-7357

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  23000027 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com