MEDICARE: NORTH VALLEY RADIATION ONCOLOGY MEDCIAL 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	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1528006228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VALLEY RADIATION ONCOLOGY MEDCIAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 511470
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-8025
Country	:	US
Telephone Number	:	512-583-0205
Fax Number	:	512-583-2001

Provider Business Practice Location Address
First Line	:	2809 OLIVE HWY
Second Line	:	SUITE 110
City	:	OROVILLE
State	:	CA
Zip	:	95966-6131
Country	:	US
Telephone Number	:	530-891-8787
Fax Number	:	530-345-4505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN WAHLEN
Credential	:	MD
Telephone Number	:	530-891-8787

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/09/2010

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