Provider Demographics
NPI:1730414285
Name:MT SHASTA HOSPITALIST SERVICES INC
Entity type:Organization
Organization Name:MT SHASTA HOSPITALIST SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-926-4874
Mailing Address - Street 1:231 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9462
Mailing Address - Country:US
Mailing Address - Phone:530-926-4874
Mailing Address - Fax:
Practice Address - Street 1:231 VILLA RD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9462
Practice Address - Country:US
Practice Address - Phone:530-926-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty