Provider Demographics
NPI:1023325347
Name:CHICO ORTHOPAEDIC SURGERY AND SPORTS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CHICO ORTHOPAEDIC SURGERY AND SPORTS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DYANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-891-6375
Mailing Address - Street 1:111 RALEY BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8351
Mailing Address - Country:US
Mailing Address - Phone:530-891-6375
Mailing Address - Fax:530-891-6952
Practice Address - Street 1:111 RALEY BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8351
Practice Address - Country:US
Practice Address - Phone:530-891-6375
Practice Address - Fax:530-891-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52675207X00000X
CAG86463207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty