Provider Demographics
NPI:1417688078
Name:SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION
Other - Org Name:GRIDLEY CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-674-2100
Mailing Address - Street 1:1215 PLUMAS ST STE 500
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3453
Mailing Address - Country:US
Mailing Address - Phone:530-898-1201
Mailing Address - Fax:530-898-1204
Practice Address - Street 1:50 EAST GRIDLEY RD
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948
Practice Address - Country:US
Practice Address - Phone:530-674-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty