Healthcare Provider Details

I. General information

NPI: 1760672521
Provider Name (Legal Business Name): MT SHASTA CARDIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W CASTLE ST STE 200
MOUNT SHASTA CA
96067-2165
US

IV. Provider business mailing address

PO BOX 1253
MOUNT SHASTA CA
96067-1253
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-4067
  • Fax: 530-926-3791
Mailing address:
  • Phone: 530-926-4401
  • Fax: 530-926-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS N SMITH
Title or Position: CARDIOLIGIST
Credential: M.D.
Phone: 530-926-4401