Provider Demographics
NPI:1275616302
Name:ENLOE MEDICAL CENTER
Entity Type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:ENLOE DME
Other - Org Type:Other Name
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-6353
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-6337
Mailing Address - Fax:530-893-6936
Practice Address - Street 1:1390 E LASSEN AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7823
Practice Address - Country:US
Practice Address - Phone:530-332-6337
Practice Address - Fax:530-893-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01959FMedicaid
CA0804930001Medicare ID - Type Unspecified