Healthcare Provider Details

I. General information

NPI: 1831644673
Provider Name (Legal Business Name): NORTHSTATE PLASTIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 EAST AVE
CHICO CA
95926-1021
US

IV. Provider business mailing address

PO BOX 8505
CHICO CA
95927-8505
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-5900
  • Fax: 530-345-5995
Mailing address:
  • Phone: 530-345-5900
  • Fax: 530-345-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MYERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-345-5900