Basic Information
| Provider Information | |||||||||
| NPI: | 1710144688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH VALLEY RADIATION ONCOLOGY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1010 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959271010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308918787 | ||||||||
| FaxNumber: | 5303454505 | ||||||||
| Practice Location | |||||||||
| Address1: | 5629 CANYON VIEW DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959695569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308918787 | ||||||||
| FaxNumber: | 5303454505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | WAHLLEN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5308918787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N/A | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.