Provider Demographics
NPI:1376631606
Name:NORTHERN CALIFORNIA SURGICAL GROUP A MED CORP
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA SURGICAL GROUP A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHEPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-2882
Mailing Address - Street 1:2656 EDITH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3030
Mailing Address - Country:US
Mailing Address - Phone:530-244-2882
Mailing Address - Fax:530-244-3703
Practice Address - Street 1:2656 EDITH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3030
Practice Address - Country:US
Practice Address - Phone:530-244-2882
Practice Address - Fax:530-244-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0043580Medicaid
CAGR0043580Medicaid