Provider Demographics
NPI:1164780573
Name:GREENVILLE RANCHERIA
Entity Type:Organization
Organization Name:GREENVILLE RANCHERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALSPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:530-528-8600
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0279
Mailing Address - Country:US
Mailing Address - Phone:530-284-7990
Mailing Address - Fax:530-284-7299
Practice Address - Street 1:343 OAK ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3304
Practice Address - Country:US
Practice Address - Phone:530-528-8600
Practice Address - Fax:530-528-8612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENVILLE RANCHERIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32161122300000X
CA56174122300000X
CA599481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty