Provider Demographics
NPI:1356578959
Name:REDDING SPINE AND SPORTS MEDICINE, INC.
Entity type:Organization
Organization Name:REDDING SPINE AND SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:DAVIDSON
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-244-4608
Mailing Address - Street 1:PO BOX 992316
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2316
Mailing Address - Country:US
Mailing Address - Phone:530-244-4608
Mailing Address - Fax:530-247-1096
Practice Address - Street 1:1945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0443
Practice Address - Country:US
Practice Address - Phone:530-244-4608
Practice Address - Fax:530-247-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58464YOtherBLUE SHIELD
CJ291AMedicare PIN