Provider Demographics
NPI:1952402190
Name:REDDING UROLOGIC ASSOCIATES, A MEDICAL CORP
Entity Type:Organization
Organization Name:REDDING UROLOGIC ASSOCIATES, A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:STRATTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-3316
Mailing Address - Street 1:2626 EDITH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3056
Mailing Address - Country:US
Mailing Address - Phone:530-241-3316
Mailing Address - Fax:530-241-6319
Practice Address - Street 1:2626 EDITH AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3056
Practice Address - Country:US
Practice Address - Phone:530-241-3316
Practice Address - Fax:530-241-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5241OtherRAILROAD MEDICARE
CAZZZ78528ZMedicaid
CA05D0617976OtherCLIA ID