Provider Demographics
NPI:1235108077
Name:ORTHOPEDIC ASSOCIATES OF NORTHERN CALIFORNIA A MEDICAL GROUP
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF NORTHERN CALIFORNIA A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DYANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-897-4500
Mailing Address - Street 1:131 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8347
Mailing Address - Country:US
Mailing Address - Phone:530-897-4500
Mailing Address - Fax:530-897-4544
Practice Address - Street 1:131 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8347
Practice Address - Country:US
Practice Address - Phone:530-897-4500
Practice Address - Fax:530-897-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ52846ZOtherBLUE SHIELD
CAGR0077320Medicaid
ZZZ13431ZMedicare ID - Type Unspecified
ZZZ52846ZOtherBLUE SHIELD