MEDICARE: SHASTA ORTHOPEDICS & SPORTS MEDICINE A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207Q00000X	Family Medicine Physician	CA
2	207XS0106X	Orthopaedic Hand Surgery Physician	CA
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	CA
4	208100000X	Physical Medicine & Rehabilitation Physician	CA
5	207X00000X	Orthopaedic Surgery Physician	CA

General Provider Information

NPI Number	:	1750493979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHASTA ORTHOPEDICS & SPORTS MEDICINE A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 991950
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96099-1950
Country	:	US
Telephone Number	:	530-246-2467
Fax Number	:	530-242-9460

Provider Business Practice Location Address
First Line	:	1255 LIBERTY STREET
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0814
Country	:	US
Telephone Number	:	530-246-2467
Fax Number	:	530-242-9460

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL E SCHWARTZ
Credential	:	MD
Telephone Number	:	530-246-2467

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	12/09/2022

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