Healthcare Provider Details

I. General information

NPI: 1760272991
Provider Name (Legal Business Name): COLUSA MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N ENRIGHT AVE
WILLOWS CA
95988-2716
US

IV. Provider business mailing address

199 E WEBSTER ST
COLUSA CA
95932-0019
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-1766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY JEAN THOMPSON
Title or Position: VP FINANCE/CFO
Credential:
Phone: 209-287-6308