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General NPI Number Information
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NPI Number | 1497783096
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Entity Type | Organization
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Legal Business Name | SEELY MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 2175 ROSALINE AVE MEDICAL STAFF OFFICE
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City | REDDING
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State | CA
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Zip | 96049-6009
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Country | US
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Telephone | 530-515-1699
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1280
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City | PALO CEDRO
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State | CA
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Zip | 96073-1280
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Country | US
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Telephone | 530-515-1699
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DR. TERI A BOSTER
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Credential | M.D.
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Telephone | 530-515-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G83413
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License Number State | CA
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