Provider Demographics
NPI:1003055740
Name:EDWARD P. RICHERT, M.D., INC.
Entity Type:Organization
Organization Name:EDWARD P. RICHERT, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-233-4680
Mailing Address - Street 1:710 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3506
Mailing Address - Country:US
Mailing Address - Phone:530-233-4680
Mailing Address - Fax:
Practice Address - Street 1:229 W MCDOWELL AVE
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3933
Practice Address - Country:US
Practice Address - Phone:530-233-7052
Practice Address - Fax:530-233-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G359110Medicaid
CA00G359110Medicaid