Basic Information
| Provider Information | |||||||||
| NPI: | 1992135339 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OROVILLE HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CORNING MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2767 OLIVE HWY | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305338500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 155 SOLANO ST | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960213511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308244663 | ||||||||
| FaxNumber: | 5308245204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2013 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KHANCHANDANI | ||||||||
| AuthorizedOfficialFirstName: | ASHOK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO V/P OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5305328509 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 230000022 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.