MANGROVE MEDICAL GROUP (NPI# 1962422238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962422238 |
| Entity Type | Organization |
| Organization Name | MANGROVE MEDICAL GROUP |
| Other Organization Name | MANGROVE LAB & X-RAY |
| Practice Address |
1040 Mangrove Ave Chico CA 95926-3509 |
| Practice Telephone | 5303450064 |
| Practice Fax Number | 5303450080 |
| Mailing Telephone | 5303450064 |
| Mailing Fax Number | 5303450080 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-08-17 |
| Authorized Official Name | ELIZABETH A MULLINS (ADMINISTRATOR) |
| Authorized Official Telephone | 5303450064 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0200X |
Clinic/Center Specialization: Radiology |
CA | Ambulatory Health Care Facilities | |
| Y | 291U00000X | Clinical Medical Laboratory | 05D0644223 | CA | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZZ58848Z | 05 |
| Other Name | Type Code |
|---|---|
| MANGROVE LAB & X-RAY | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386625796 | Mangrove Medical Group | Clinic/Center | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2005-11-11 |
| 1326038381 | Mangrove Medical Group | Obstetrics & Gynecology | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2005-10-21 |
| Street Address |
1040 MANGROVE AVE |
| City | CHICO |
| State | CA |
| Zip Code | 95926-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497752877 | Gregory Lynn Davis | Obstetrics & Gynecology | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2005-06-30 |
| 1144680141 | Kevin R Sorensen | Emergency Medicine | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2016-03-03 |
| 1306277686 | Patria Mckiernan | Nurse Practitioner | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2013-12-11 |
| 1346687225 | Robert Stephen Avilla | Family Medicine | 1040 Mangrove Ave, Chico, CA 95926 | 2013-05-31 |
| 1114030095 | Hugo A. Leon | Family Medicine | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-08-16 |
| 1871528117 | Dean P Smith | General Practice | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-07-12 |
| 1407881741 | Kurt E Johnson | Family Medicine | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-07-12 |
| 1437180312 | Barbara J Wilde | Nurse Practitioner | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-07-06 |
| 1912938887 | Dewayne E Caviness | General Practice | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-07-06 |
| 1245261114 | Randall S Williams | General Practice | 1040 Mangrove Ave, Chico, CA 95926-3509 | 2006-07-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104332576 | Asheley Dawn Kimble | Registered Nurse | 592 Lindo Ave, Chico, CA 95926 | 2017-12-21 |
| 1275050635 | Wa Meng Vang | Counselor | 560 Cohasset Rd #180, Chico, CA 95926 | 2017-08-26 |
| 1922538677 | Lisa Ann Milardovich | Physical Medicine & Rehabilitation | 1576 Hawthorne Ave, Chico, CA 95926 | 2017-06-15 |
| 1205364700 | Andrew Vercellino | Chiropractor | 1281 East Ave #100, Chico, CA 95926 | 2017-05-26 |
| 1205389095 | Michele Lando | Social Worker | 572 Rio Lindo Ave Ste 108, Chico, CA 95926 | 2016-07-27 |
| 1215397864 | Joseph Boone Wills IIi | Marriage & Family Therapist | 6 Governors Ln Ste C, Chico, CA 95926 | 2016-02-24 |
| 1356723001 | Erica White | Counselor | 109 Parmac Road, Suite 1, Chico, CA 95926 | 2015-06-18 |
| 1902285208 | Genuine Dbt Licensed Clinical Social Worker Inc | Psychologist | 1140 Mangrove Ave Ste D, Chico, CA 95926 | 2015-05-20 |
| 1255724324 | Linda K Zimbelman | Nurse Practitioner | 1645 Esplanade #1, Chico, CA 95926 | 2015-03-12 |
| 1366851040 | Jose Mendoza | Counselor | 590 Rio Lindo Avenue, Chico, CA 95926 | 2014-08-07 |
| Find all providers in zip 95926 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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|---|---|---|---|---|
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| 1619005170 | Butte County Department of Public Health, Laboratory | Clinical Medical Laboratory | 695 Oleander Ave, Chico, CA 95926-3924 | 2007-02-28 |
| 1245396605 | Unilab Corporation | Clinical Medical Laboratory | 670 Rio Lindo Ave, Ste 500, Chico, CA 95926-1827 | 2006-12-29 |
| 1932298247 | North State Sleep Lab | Clinical Medical Laboratory | 130 Independence Cir, Suite 1, Chico, CA 95973-4918 | 2006-10-12 |
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| 1083212351 | Telomere Diagnostics, Inc. | Clinical Medical Laboratory | 2688 Middlefield Rd Ste A, Redwood City, CA 94063-3483 | 2020-10-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.