Provider Demographics
NPI:1619053899
Name:OBSTETRICS AND GYNECOLOGY MEDICAL ASSOCIATES OF REDDING, INC.
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY MEDICAL ASSOCIATES OF REDDING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POGODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-2130
Mailing Address - Street 1:2626 EDITH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-244-2130
Mailing Address - Fax:530-244-8071
Practice Address - Street 1:2650 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-244-2130
Practice Address - Fax:530-244-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A432370Medicaid
CA00G399660Medicaid
CA00A325060Medicaid
E07465Medicare UPIN
A48037Medicare UPIN
CA00A325060Medicare ID - Type Unspecified
00G399660Medicare ID - Type Unspecified
CA00A325060Medicaid
CA00G399660Medicaid