Provider Demographics
NPI:1437375359
Name:KIMBERLY A. PAGE, M.D., INC.
Entity Type:Organization
Organization Name:KIMBERLY A. PAGE, M.D., INC.
Other - Org Name:NORTH VALLEY NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-246-2207
Mailing Address - Street 1:1388 COURT STREET
Mailing Address - Street 2:SUITE H
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1650
Mailing Address - Country:US
Mailing Address - Phone:530-246-2207
Mailing Address - Fax:530-243-6835
Practice Address - Street 1:1388 COURT STREET
Practice Address - Street 2:SUITE H
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1650
Practice Address - Country:US
Practice Address - Phone:530-246-2207
Practice Address - Fax:530-243-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64229174400000X
CA207T00000X
CAPA18032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642290Medicaid
CA1215930250OtherKP NPI
CA1215007661OtherAB'S NPI
CAZZZ31836ZMedicare ID - Type Unspecified
CA00G642290Medicaid