1861616567 NPI number — RONALD G CHAMBERS INC

Table of content: (NPI 1861616567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861616567 NPI number — RONALD G CHAMBERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD G CHAMBERS 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:
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:
1861616567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4174 ASHBY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHASTA LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96019-9215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-275-3094
Provider Business Mailing Address Fax Number:
530-275-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4174 ASHBY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHASTA LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96019-9215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-275-3094
Provider Business Practice Location Address Fax Number:
530-275-0803
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMBERS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT, CORPORATION
Authorized Official Telephone Number:
530-275-3094

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G27170 , 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)

  • Identifier: 00G271700 . This is a "MEDICARE LEGACY NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861616567 . This is a "MEDICARE NPI ORGANIZ #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G271700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0714372 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ02677Z . This is a "NP PPIN # FOR GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G27170 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: Q71604 . This is a "NP UPIN FOR GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1861616567 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G271700 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com