Provider Demographics
NPI:1730351206
Name:KEVIN MITCHELL MD PC
Entity type:Organization
Organization Name:KEVIN MITCHELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRELLE
Authorized Official - Middle Name:LB
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-749-0700
Mailing Address - Street 1:710 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5668
Mailing Address - Country:US
Mailing Address - Phone:530-749-0700
Mailing Address - Fax:530-749-9298
Practice Address - Street 1:710 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5668
Practice Address - Country:US
Practice Address - Phone:530-749-0700
Practice Address - Fax:530-749-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8671202086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867120Medicaid
CA00G867120Medicaid
CAZZZ02919ZMedicare PIN
MOE18514Medicare UPIN