Provider Demographics
NPI:1982741674
Name:FEATHER RIVER CRITICAL CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FEATHER RIVER CRITICAL CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-246-9890
Mailing Address - Street 1:PO BOX 991844
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1844
Mailing Address - Country:US
Mailing Address - Phone:530-246-9890
Mailing Address - Fax:530-246-9808
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2549
Practice Address - Country:US
Practice Address - Phone:530-246-9890
Practice Address - Fax:530-246-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G111102Medicare PIN
CAA38222Medicare UPIN
CAI52089Medicare UPIN
CAZZZ05264ZMedicare PIN
CA020A95451Medicare PIN