=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659694560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEATHER RIVER CARDIOLOGY MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2010
-----------------------------------------------------
Last Update Date | 12/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 G ST STE 208
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-1122
-----------------------------------------------------
Fax | 530-741-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 G ST SUITE 208
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-1122
-----------------------------------------------------
Fax | 530-741-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL L. CHIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 530-741-1122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G41895
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------