Provider Demographics
NPI:1457357394
Name:CHICO ENDOSCOPY CENTER
Entity type:Organization
Organization Name:CHICO ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-6810
Mailing Address - Street 1:888 LAKESIDE VLG COMMONS
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-3979
Mailing Address - Country:US
Mailing Address - Phone:530-332-6810
Mailing Address - Fax:530-899-5743
Practice Address - Street 1:888 LAKESIDE VLG COMMONS
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-3979
Practice Address - Country:US
Practice Address - Phone:530-332-6810
Practice Address - Fax:530-899-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01574FMedicaid
CASUR01574FMedicaid