1215920319 NPI number — DR. RONALD G CHAMBERS I M.D.

Table of content: DR. RONALD G CHAMBERS I M.D. (NPI 1215920319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215920319 NPI number — DR. RONALD G CHAMBERS I M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMBERS
Provider First Name:
RONALD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1215920319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
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:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: 05D0714372 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 21565 . This is a "WEB MD ACCT NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS . This is a "00G271700" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4490118 . This is a "MEDI-CAL PIN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1243370356 . This is a "VITERA ACCOUNT" 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: ZZZ01370Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE SHIELD . This is a "00G271700" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ01370Z . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G271700 . This is a "BLUE SHIELD ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G271700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013204 . This is a "AMER BD OF FAMILY PRACTIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G27170 . This is a "CALIF STATE LICENSE NUMBE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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