Provider Demographics
NPI:1336460641
Name:SHASTA MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:SHASTA MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STRAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-222-9444
Mailing Address - Street 1:310 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2503
Mailing Address - Country:US
Mailing Address - Phone:530-222-9444
Mailing Address - Fax:530-222-1634
Practice Address - Street 1:310 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2503
Practice Address - Country:US
Practice Address - Phone:530-222-9444
Practice Address - Fax:530-222-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26960332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6485570001Medicare NSC