Provider Demographics
NPI:1700028560
Name:SISKIYOU PROFESSIONAL MEDICAL SERVICE, PROF. CORP.
Entity Type:Organization
Organization Name:SISKIYOU PROFESSIONAL MEDICAL SERVICE, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-842-2800
Mailing Address - Street 1:P.O. BOX 1667
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3450
Mailing Address - Country:US
Mailing Address - Phone:530-842-2800
Mailing Address - Fax:
Practice Address - Street 1:6736 QUAIL RUN ROAD
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3540
Practice Address - Country:US
Practice Address - Phone:530-842-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty