Provider Demographics
NPI:1215031554
Name:OROVILLE HOSPITAL
Entity Type:Organization
Organization Name:OROVILLE HOSPITAL
Other - Org Name:OROVILLE PEDIATRIC PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-533-8550
Mailing Address - Street 1:2767 OLIVE HWY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:SUITE 270
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6131
Practice Address - Country:US
Practice Address - Phone:530-533-4422
Practice Address - Fax:530-532-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08582FMedicaid
CARHM08582FMedicaid