=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669214995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MHC SCADDEN, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2024
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 N CALIFORNIA ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95204-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-943-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1049 E AUGUSTA ST UNIT 954
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95258-4032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MICK'L HAYES C SCADDEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 707-955-5575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------