=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952402190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDDING UROLOGIC ASSOCIATES, A MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2626 EDITH AVE STE C
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-241-3316
-----------------------------------------------------
Fax | 530-241-6319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2626 EDITH AVE STE C
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-241-3316
-----------------------------------------------------
Fax | 530-241-6319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATION OFFICER
-----------------------------------------------------
Name | PATRICK T FOWLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 530-241-3316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------