Provider Demographics
NPI:1245249770
Name:SHASTA CRITICAL CARE SPECIALISTS MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:SHASTA CRITICAL CARE SPECIALISTS MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-232-3000
Mailing Address - Street 1:2701 OLD EUREKA WAY STE 1E
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0228
Mailing Address - Country:US
Mailing Address - Phone:530-232-3000
Mailing Address - Fax:530-242-8545
Practice Address - Street 1:2701 OLD EUREKA WAY
Practice Address - Street 2:SUITE 1E
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0228
Practice Address - Country:US
Practice Address - Phone:530-232-3000
Practice Address - Fax:530-232-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty