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NPI Code Detail

MEDICARE: RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION

MEDICARE: RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION
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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number : 1760220842
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 376 HARTNELL AVE STE A
Second Line :
City : REDDING
State : CA
Zip : 96002-1881
Country : US
Telephone Number : 530-806-0404
Fax Number : 888-633-1441
Provider Business Practice Location Address
First Line : 376 HARTNELL AVE STE A
Second Line :
City : REDDING
State : CA
Zip : 96002-1881
Country : US
Telephone Number : 530-806-0404
Fax Number : 888-633-1441
Authorized Official
Title or Position : BILLING ADMINISTRATOR
Name : AMIE WEHUNT
Credential :
Telephone Number : 530-646-7237
Provider Enumeration Date : 07/15/2024
Last Update Date : 03/10/2026

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Directions to “RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION ” Practice Location

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