Provider Demographics
NPI:1982615779
Name:CANCER CARE CONSULTANTS OF NORTHERN CALIFORNIA A MEDICAL GROUP
Entity Type:Organization
Organization Name:CANCER CARE CONSULTANTS OF NORTHERN CALIFORNIA A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-2223
Mailing Address - Street 1:PO BOX 993100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-3100
Mailing Address - Country:US
Mailing Address - Phone:530-244-2223
Mailing Address - Fax:530-244-4799
Practice Address - Street 1:902 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2143
Practice Address - Country:US
Practice Address - Phone:530-926-7234
Practice Address - Fax:530-926-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0054240Medicaid
CAGR0054240Medicaid
CACS7810Medicare PIN