MEDICARE: RONALD G CHAMBERS 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	G27170	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G271700	OTHER		MEDICARE LEGACY NUMBER
2	1861616567	OTHER		MEDICARE NPI ORGANIZ #

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
4	05D0714372	OTHER	CA	CLIA
5	ZZZ02677Z	OTHER	CA	NP PPIN # FOR GROUP
6	G27170	OTHER	CA	STATE LICENSE NUMBER
7	Q71604	OTHER	CA	NP UPIN FOR GROUP
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	00G271700	OTHER	CA	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1861616567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD G CHAMBERS INC

Provider Business Mailing Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-275-3094
Fax Number	:	530-275-0803

Provider Business Practice Location Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-275-3094
Fax Number	:	530-275-0803

Authorized Official
Title or Position	:	PRESIDENT, CORPORATION
Name	:	DR. RONALD G CHAMBERS SR.
Credential	:	M.D.
Telephone Number	:	530-275-3094

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/06/2010

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Directions to “RONALD G CHAMBERS INC ” Practice Location

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