Provider Demographics
NPI:1033187182
Name:SHASTA REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SHASTA REGIONAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, NON GOVERNMENT PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-722-1316
Mailing Address - Street 1:PO BOX 496072
Mailing Address - Street 2:ATTENTION: PATIENT FINANCIAL SERVICES
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6072
Mailing Address - Country:US
Mailing Address - Phone:530-722-1316
Mailing Address - Fax:530-224-1152
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:ATTENTION: PATIENT FINANCIAL SERVICES
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-722-1316
Practice Address - Fax:530-224-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30312JMedicaid
CAHSP40312JMedicaid
CAHSP40312JMedicaid