1467497578 NPI number — COMPREHENSIVE RENAL CARE GROUP A MEDICAL CORPORATION

Table of content: ANTHONY W. BRACKEN MD (NPI 1770525438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467497578 NPI number — COMPREHENSIVE RENAL CARE GROUP A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE RENAL CARE GROUP A MEDICAL CORPORATION
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:
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:
1467497578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95927-6789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-892-2300
Provider Business Mailing Address Fax Number:
530-894-5890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 COHASSET RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-2243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-892-2300
Provider Business Practice Location Address Fax Number:
530-894-5890
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASHIR
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
530-892-2300

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0100320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC5283 . This is a "MEDICARE RAILROAD #" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com