Healthcare Provider Details

I. General information

NPI: 1710073887
Provider Name (Legal Business Name): NORTH VALLEY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 SOUTH ST
REDDING CA
96001-2105
US

IV. Provider business mailing address

2205 HILLTOP DR # 1
REDDING CA
96002-0511
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-1415
  • Fax:
Mailing address:
  • Phone: 530-242-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA30743
License Number StateCA

VIII. Authorized Official

Name: JAMES GREGORY WHITE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-242-1415