Provider Demographics
NPI:1861616567
Name:RONALD G CHAMBERS INC
Entity type:Organization
Organization Name:RONALD G CHAMBERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:530-275-3094
Mailing Address - Street 1:4174 ASHBY CT
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9215
Mailing Address - Country:US
Mailing Address - Phone:530-275-3094
Mailing Address - Fax:530-275-0803
Practice Address - Street 1:4174 ASHBY CT
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9215
Practice Address - Country:US
Practice Address - Phone:530-275-3094
Practice Address - Fax:530-275-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G271700OtherMEDICARE LEGACY NUMBER
1861616567OtherMEDICARE NPI ORGANIZ #
CA00G271700Medicaid
CA05D0714372OtherCLIA
CAZZZ02677ZOtherNP PPIN # FOR GROUP
CAG27170OtherSTATE LICENSE NUMBER
CAQ71604OtherNP UPIN FOR GROUP
CA1861616567Medicaid
CA00G271700OtherBLUE CROSS PROVIDER NUMBE
CAZZZ01370ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAQ71604OtherNP UPIN FOR GROUP
CA00G271700OtherBLUE CROSS PROVIDER NUMBE