Provider Demographics
NPI:1497783096
Name:SEELY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SEELY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-515-1699
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-1280
Mailing Address - Country:US
Mailing Address - Phone:530-515-1699
Mailing Address - Fax:
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96049-6009
Practice Address - Country:US
Practice Address - Phone:530-515-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83413261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center