Provider Demographics
NPI:1215178843
Name:LANDES MEDICAL GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LANDES MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-348-4193
Mailing Address - Street 1:2485 NOTRE DAME BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7165
Mailing Address - Country:US
Mailing Address - Phone:530-899-9500
Mailing Address - Fax:530-899-4040
Practice Address - Street 1:2485 NOTRE DAME BLVD STE 230
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7165
Practice Address - Country:US
Practice Address - Phone:530-899-9500
Practice Address - Fax:530-899-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A682790261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care