Provider Demographics
NPI:1962479261
Name:REDDING ANESTHESIA ASSOCIATES MEDICAL GROUP
Entity Type:Organization
Organization Name:REDDING ANESTHESIA ASSOCIATES MEDICAL GROUP
Other - Org Name:THERAPEUTIC PAIN MANAGEMENT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHISHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:DHRUVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-247-7246
Mailing Address - Street 1:1335 BUENAVENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0160
Mailing Address - Country:US
Mailing Address - Phone:530-247-7246
Mailing Address - Fax:530-245-0849
Practice Address - Street 1:1335 BUENAVENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-247-7246
Practice Address - Fax:530-245-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055650Medicaid
CAZZZ37169ZMedicare ID - Type Unspecified
CAGR0055650Medicaid