Basic Information
| Provider Information | |||||||||
| NPI: | 1629583018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEAR CREEK MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 738 SUNRIVER LN | ||||||||
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| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303552670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 BUTTE ST | ||||||||
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| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302445400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5303552670 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | A86727 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.