Healthcare Provider Details

I. General information

NPI: 1316497910
Provider Name (Legal Business Name): MISSION RANCH PRIMARY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MISSION RANCH BLVD SUITE 10
CHICO CA
95926-5137
US

IV. Provider business mailing address

114 MISSION RANCH BLVD SUITE 10
CHICO CA
95926-5137
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-0500
  • Fax: 530-345-2532
Mailing address:
  • Phone: 530-894-0500
  • Fax: 530-345-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES WESTCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 530-894-0500