Provider Demographics
NPI:1164885604
Name:ENLOE MEDICAL CENTER
Entity Type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:ENLOE WOUND/OSTOMY & HYPERBARIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-6733
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7300
Mailing Address - Fax:
Practice Address - Street 1:1026 MANGROVE AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3556
Practice Address - Country:US
Practice Address - Phone:530-332-7144
Practice Address - Fax:530-893-6950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLOE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-01
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000027207PE0005X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty