MEDICARE: ENLOE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK2203	OTHER	CA	MEDICARE RAILROAD
2	C40478	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396753281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLOE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1531 ESPLANADE
Second Line	:	ATTN: FINANCE
City	:	CHICO
State	:	CA
Zip	:	95926-3310
Country	:	US
Telephone Number	:	530-332-7479
Fax Number	:	530-893-6853

Provider Business Practice Location Address
First Line	:	888 LAKESIDE VLG CMNS
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-3979
Country	:	US
Telephone Number	:	530-332-6850
Fax Number	:

Authorized Official
Title or Position	:	VP/CFO
Name	:	KEVIN WOODWARD
Credential	:
Telephone Number	:	530-332-6733

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/03/2021

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Directions to “ENLOE MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

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