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General NPI Number Information
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NPI Number | 1164421004
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Entity Type | Organization
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Legal Business Name | CHICO SURGERY CENTER LP
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 615 W EAST AVE
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City | CHICO
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State | CA
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Zip | 95926-7201
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Country | US
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Telephone | 530-895-1800
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Fax | 530-895-1877
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Provider Business Mailing Address
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Address Line | 615 W EAST AVE
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City | CHICO
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State | CA
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Zip | 95926-7201
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Country | US
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Telephone | 530-895-1800
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Fax | 530-895-1877
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Authorized Official
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Title or Position | MEDICARE AUTHORIZED OFFICIAL
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Name | JENETHA D MORAN
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Credential |
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Telephone | 972-763-3893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 230000315
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License Number State | CA
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