Provider Demographics
NPI:1326034281
Name:ROSS W TYE MD PHD INC
Entity Type:Organization
Organization Name:ROSS W TYE MD PHD INC
Other - Org Name:ROSS TYE MD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-865-3400
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-4102
Mailing Address - Country:US
Mailing Address - Phone:530-865-3400
Mailing Address - Fax:530-865-2477
Practice Address - Street 1:1361 CORTINA DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2402
Practice Address - Country:US
Practice Address - Phone:530-865-3400
Practice Address - Fax:530-865-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM553840FMedicaid
CA553840Medicare Oscar/Certification
CABF583BMedicare PIN
CARHM553840FMedicaid