Provider Demographics
NPI:1770666034
Name:ANESTHESIA ASSOCIATES OF CHICO
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF CHICO
Other - Org Name:ANESTHESIA ASSOCIATES OF CHICO MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TYM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-693-2787
Mailing Address - Street 1:121 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8347
Mailing Address - Country:US
Mailing Address - Phone:530-230-2000
Mailing Address - Fax:
Practice Address - Street 1:121 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8347
Practice Address - Country:US
Practice Address - Phone:530-230-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065400Medicaid
CACD7016Medicare PIN
CAZZZ00680ZMedicare ID - Type Unspecified
CAZZZ00680ZMedicare PIN