Provider Demographics
NPI:1477975613
Name:ENLOE MEDICAL CENTER
Entity Type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:ENLOE TRAUMA & SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:E
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:530-893-6853
Practice Address - Street 1:1600 ESPLANADE
Practice Address - Street 2:SUITE C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3369
Practice Address - Country:US
Practice Address - Phone:530-332-7300
Practice Address - Fax:530-893-6885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLOE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000027208600000X
261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty