Provider Demographics
NPI:1710035035
Name:PLASTIC SURGERY ASSOCIATES OF REDDING A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES OF REDDING A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-1300
Mailing Address - Street 1:2439 SONOMA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3026
Mailing Address - Country:US
Mailing Address - Phone:530-241-1300
Mailing Address - Fax:530-241-0200
Practice Address - Street 1:2439 SONOMA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3026
Practice Address - Country:US
Practice Address - Phone:530-241-1300
Practice Address - Fax:530-241-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37414ZOtherMEDICARE GROUP ID
CAGR0057070Medicaid
CAGR0057070Medicaid