Provider Demographics
NPI:1659694560
Name:FEATHER RIVER CARDIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:FEATHER RIVER CARDIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-741-1122
Mailing Address - Street 1:414 G ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5663
Mailing Address - Country:US
Mailing Address - Phone:530-741-1122
Mailing Address - Fax:530-741-1155
Practice Address - Street 1:414 G ST STE 208
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5669
Practice Address - Country:US
Practice Address - Phone:530-741-1122
Practice Address - Fax:530-741-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41895207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3269539Medicaid
CAA48730Medicare UPIN