Provider Demographics
NPI:1972511095
Name:SHASTA MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:SHASTA MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-6716
Mailing Address - Street 1:1555 EAST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:530-244-6716
Mailing Address - Fax:
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-244-6716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF10686OtherUPIN
CACE8794OtherRAILROAD MEDICARE
CAG62314OtherUPIN
CAE32911OtherUPIN
CAH31167OtherUPIN
CAF36718OtherUPIN
CAG15875OtherUPIN
CAGR0070840Medicaid
CAH31167OtherUPIN