MEDICARE: REDDING RANCHERIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1831724053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDDING RANCHERIA

Provider Business Mailing Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-224-2700
Fax Number	:	530-224-2738

Provider Business Practice Location Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-224-2700
Fax Number	:	530-224-2738

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TAMRA DAWN OLSON
Credential	:
Telephone Number	:	530-224-2700

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	09/21/2021

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Directions to “REDDING RANCHERIA ” Practice Location

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