Provider Demographics
NPI:1639404999
Name:HARRY W. DANIELL, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HARRY W. DANIELL, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DANIELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-7050
Mailing Address - Street 1:2626 EDITH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3056
Mailing Address - Country:US
Mailing Address - Phone:530-241-7050
Mailing Address - Fax:530-241-1214
Practice Address - Street 1:2626 EDITH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3056
Practice Address - Country:US
Practice Address - Phone:530-241-7050
Practice Address - Fax:530-241-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G83810Medicaid
CACI543AMedicare PIN
CACI543AMedicare Oscar/Certification
CAA58417Medicare UPIN