1861375743 NPI number — COMMUNITY MEDICAL SPECIALISTS INC

Table of content: GARY J. BUTLER M.S. (NPI 1629197462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861375743 NPI number — COMMUNITY MEDICAL SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEDICAL SPECIALISTS INC
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:
1861375743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
457 KNOLLCREST DR STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96002-0121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 LIVE OAK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-4071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
279-274-0744
Provider Business Practice Location Address Fax Number:
279-274-0745
Provider Enumeration Date:
07/29/2025

Additional Information

Authorized Official

Authorized Official Last Name:
ADDONIZIO
Authorized Official First Name:
ORNELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
530-392-4399

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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