Lassen Medical Group
Organization Active NPI Family Medicine Physician · Corning, CA
NPI 1013056910 · NPPES record last updated Oct 8, 2007
Key facts
- NPI
- 1013056910
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- LASSEN MEDICAL GROUP
- Practice address
- 702 Solano Street
Corning, CA 96021 - Phone
- (530) 824-9590
- NPI assigned
- Feb 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Kim Hake
- Title
- Manager
- Phone
- (530) 528-4419
National Provider Directory
Locations
2450 Sister Mary Columba Dr
Red Bluff, CA 96080
Phone (530) 527-0414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
702 Solano Street
Corning, CA 96021
Mailing address
2450 Sister Mary Columba Drive
Red Bluff, CA 96080
Phone (530) 824-9590
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0089251 | Medicaid | CA | |
| RHM53956F | Medicaid | CA |
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All providers in Corning, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.