Healthcare Provider Details

I. General information

NPI: 1164885604
Provider Name (Legal Business Name): ENLOE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 MANGROVE AVE STE 10
CHICO CA
95926-3556
US

IV. Provider business mailing address

1531 ESPLANADE ATTN: FINANCE
CHICO CA
95926-3310
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-7144
  • Fax: 530-893-6950
Mailing address:
  • Phone: 530-332-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number230000027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number230000027
License Number StateCA

VIII. Authorized Official

Name: KEVIN WOODWARD
Title or Position: CFO/VP
Credential:
Phone: 530-332-6733