Provider Demographics
NPI:1720099328
Name:ENLOE MEDICAL CENTER
Entity type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-6733
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7300
Mailing Address - Fax:530-893-6853
Practice Address - Street 1:185 E 7TH AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3356
Practice Address - Country:US
Practice Address - Phone:530-332-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLOE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40478OtherMEDICARE RAILROAD
CAHSP40039FMedicaid
CACK2203OtherMEDICARE RAILROAD
CAC40478OtherMEDICARE RAILROAD