Provider Demographics
NPI:1700223211
Name:CHICO IMMEDIATE CARE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CHICO IMMEDIATE CARE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:STLOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-865-3400
Mailing Address - Street 1:1361 CORTINA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-2402
Mailing Address - Country:US
Mailing Address - Phone:530-865-3400
Mailing Address - Fax:530-865-3386
Practice Address - Street 1:1361 CORTINA DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2402
Practice Address - Country:US
Practice Address - Phone:530-865-3400
Practice Address - Fax:530-865-3386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICO IMMEDIATE CARE MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-24
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00293MMedicare PIN
CA0833990003Medicare NSC