Provider Demographics
NPI:1487640868
Name:REDDING FAMILY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:REDDING FAMILY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:CIVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-4034
Mailing Address - Street 1:2510 AIRPARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2449
Mailing Address - Country:US
Mailing Address - Phone:530-244-4034
Mailing Address - Fax:530-244-1821
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-244-4034
Practice Address - Fax:530-244-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01078ZMedicare PIN
CACD4198Medicare PIN
CA0966250003Medicare NSC