Provider Demographics
NPI:1043219181
Name:REDDING CANCER TREATMENT CENTER
Entity type:Organization
Organization Name:REDDING CANCER TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOBBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-245-5900
Mailing Address - Street 1:PO BOX 994032
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4032
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:963 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0828
Practice Address - Country:US
Practice Address - Phone:530-245-5900
Practice Address - Fax:530-245-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE-GROUP2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087030Medicaid
CAZZZ42223ZMedicare ID - Type Unspecified