MEDICARE: REDDING FAMILY MEDICAL GROUP INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1487640868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDDING FAMILY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2510 AIRPARK DR
Second Line	:	SUITE 201
City	:	REDDING
State	:	CA
Zip	:	96001-2449
Country	:	US
Telephone Number	:	530-244-4034
Fax Number	:	530-244-1821

Provider Business Practice Location Address
First Line	:	2510 AIRPARK DR
Second Line	:	SUITE 201
City	:	REDDING
State	:	CA
Zip	:	96001-2449
Country	:	US
Telephone Number	:	530-244-4034
Fax Number	:	530-244-1821

Authorized Official
Title or Position	:	CORPORATE VICE PRESIDENT
Name	:	DR. TOLLIN K SULLIVAN
Credential	:	M.D.
Telephone Number	:	530-244-4034

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	04/06/2026

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