Healthcare Provider Details

I. General information

NPI: 1801226162
Provider Name (Legal Business Name): ENLOE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RALEY BLVD SUITE 100
CHICO CA
95928-8351
US

IV. Provider business mailing address

1531 ESPLANADE ATTN: FINANCE
CHICO CA
95926-3310
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-8800
  • Fax: 530-894-8929
Mailing address:
  • Phone: 530-332-7300
  • Fax: 530-893-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number230000027
License Number StateCA

VIII. Authorized Official

Name: MYRON E. MACHULA
Title or Position: VP/CFO
Credential:
Phone: 530-332-7357