Provider Demographics
NPI:1669884250
Name:CHICO IMMEDIATE CARE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:CHICO IMMEDIATE CARE MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-891-1676
Mailing Address - Street 1:376 VALLOMBROSA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3900
Mailing Address - Country:US
Mailing Address - Phone:530-891-1676
Mailing Address - Fax:530-891-1833
Practice Address - Street 1:251 COHASSET RD STE 300
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2235
Practice Address - Country:US
Practice Address - Phone:530-891-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center