Provider Demographics
NPI:1366830507
Name:ENLOE MEDICAL CENTER
Entity Type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:ENLOE NEUROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-7357
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7300
Mailing Address - Fax:
Practice Address - Street 1:1421 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3226
Practice Address - Country:US
Practice Address - Phone:530-332-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLOE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2300000272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty