Healthcare Provider Details

I. General information

NPI: 1881613669
Provider Name (Legal Business Name): AMPLA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 COHASSET RD
CHICO CA
95926-5513
US

IV. Provider business mailing address

PO BOX AD
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-6065
  • Fax:
Mailing address:
  • Phone: 530-751-3778
  • Fax: 530-751-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: VICKI L CHISSIE
Title or Position: BILLING ACCOUNT MANAGER
Credential:
Phone: 530-751-3778