Provider Demographics
NPI:1538488853
Name:TE LAYNE MD INC
Entity Type:Organization
Organization Name:TE LAYNE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-893-4200
Mailing Address - Street 1:270 COHASSET RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2262
Mailing Address - Country:US
Mailing Address - Phone:530-893-4200
Mailing Address - Fax:530-893-4222
Practice Address - Street 1:270 COHASSET RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2262
Practice Address - Country:US
Practice Address - Phone:530-893-4200
Practice Address - Fax:530-893-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADQ8575OtherMEDICARE RAILROAD
CADQ8575OtherMEDICARE RAILROAD