Provider Demographics
NPI:1851339519
Name:NORTH VALLEY CARDIOTHORACIC SURGEONS MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTH VALLEY CARDIOTHORACIC SURGEONS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:POA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-894-3278
Mailing Address - Street 1:PO BOX 3302
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-3302
Mailing Address - Country:US
Mailing Address - Phone:530-894-3278
Mailing Address - Fax:530-894-3613
Practice Address - Street 1:1430 ESPLANADE
Practice Address - Street 2:SUITE 10
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3366
Practice Address - Country:US
Practice Address - Phone:530-894-3278
Practice Address - Fax:530-894-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ21993ZMedicare ID - Type Unspecified