Provider Demographics
NPI:1689617045
Name:NORTH VALLEY RADIATION ONCOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NORTH VALLEY RADIATION ONCOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-891-8787
Mailing Address - Street 1:PO BOX 511470
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-8025
Mailing Address - Country:US
Mailing Address - Phone:512-583-0205
Mailing Address - Fax:512-583-2001
Practice Address - Street 1:265 COHASSET RD
Practice Address - Street 2:SUITE # 140
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2273
Practice Address - Country:US
Practice Address - Phone:530-332-3917
Practice Address - Fax:530-893-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ 21624 ZMedicare ID - Type Unspecified