Provider Demographics
NPI:1265574818
Name:ROY V. DITCHEY, M.D., INC.
Entity type:Organization
Organization Name:ROY V. DITCHEY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-7192
Mailing Address - Street 1:2638 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3043
Mailing Address - Country:US
Mailing Address - Phone:530-244-7192
Mailing Address - Fax:
Practice Address - Street 1:2638 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-244-7192
Practice Address - Fax:530-244-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37783207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB85551Medicare UPIN
CAZZZ06368ZMedicare Oscar/Certification