Healthcare Provider Details

I. General information

NPI: 1184785255
Provider Name (Legal Business Name): MARK L BLEDSOE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COHASSET ROAD SUITE E
CHICO CA
95926
US

IV. Provider business mailing address

PO BOX 4334
YANKEE HILL CA
95965
US

V. Phone/Fax

Practice location:
  • Phone: 530-895-6650
  • Fax: 530-895-6597
Mailing address:
  • Phone: 530-532-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: