MEDICARE: AMPLA HEALTH

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	261QD0000X	Dental Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	550001829	OTHER	CA	CALIF DEPT OF PUBLIC HEALTH

General Provider Information

NPI Number	:	1881613669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPLA HEALTH

Provider Business Mailing Address
First Line	:	PO BOX AD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95992-1396
Country	:	US
Telephone Number	:	530-751-3778
Fax Number	:	530-751-1237

Provider Business Practice Location Address
First Line	:	285 COHASSET RD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-5513
Country	:	US
Telephone Number	:	530-342-6065
Fax Number	:

Authorized Official
Title or Position	:	BILLING ACCOUNT MANAGER
Name	:	VICKI L CHISSIE
Credential	:
Telephone Number	:	530-751-3778

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/03/2024

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Directions to “AMPLA HEALTH ” Practice Location

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