Provider Demographics
NPI:1780724344
Name:NORTH VALLEY GASTROENTEROLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:NORTH VALLEY GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CCRN
Authorized Official - Phone:530-671-3671
Mailing Address - Street 1:870 SHASTA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4152
Mailing Address - Country:US
Mailing Address - Phone:530-671-3671
Mailing Address - Fax:530-671-3980
Practice Address - Street 1:870 SHASTA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4152
Practice Address - Country:US
Practice Address - Phone:530-671-3671
Practice Address - Fax:530-671-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G545060Medicaid
CA00G545060Medicaid