Provider Demographics
NPI:1225041114
Name:OROVILLE INTERNAL MEDICINE MEDICAL GROUP,INC.
Entity Type:Organization
Organization Name:OROVILLE INTERNAL MEDICINE MEDICAL GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-532-3603
Mailing Address - Street 1:2721 OLIVE HWY STE 12A
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6115
Mailing Address - Country:US
Mailing Address - Phone:530-533-6061
Mailing Address - Fax:530-533-4438
Practice Address - Street 1:2721 OLIVE HWY STE 12A
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6115
Practice Address - Country:US
Practice Address - Phone:530-533-6061
Practice Address - Fax:530-533-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0014101Medicaid
CAZZZ75470ZMedicare ID - Type Unspecified
CACR0302Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD MED