Healthcare Provider Details

I. General information

NPI: 1275616302
Provider Name (Legal Business Name): ENLOE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 E LASSEN AVE
CHICO CA
95973-7823
US

IV. Provider business mailing address

1531 ESPLANADE
CHICO CA
95926-3310
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-6337
  • Fax: 530-893-6936
Mailing address:
  • Phone: 530-332-6337
  • Fax: 530-893-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MYRON MACHULA
Title or Position: VP/CFO
Credential:
Phone: 530-332-6353