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GREENVILLE RANCHERIA
NPI 1013882877
Internal Medicine - Cardiovascular Disease in Redding, CA

Active since October 09, 2025CLIA 05D0914600 · Waiver
2638 EDITH AVE, REDDING, CA 96001(530) 244-7192(530) 244-4185 Get Directions Write a Review

NPPES record last updated: October 9, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Greenville Rancheria NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREENVILLE RANCHERIA (NPI 1013882877) is a healthcare organization registered as a cardiovascular disease in Redding, California and active in the NPI registry since October 2025. The organization holds a CLIA Waiver certificate valid through July 31, 2027 and lists Antonia Louise Hayworth, Billing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1013882877
Entity TypeOrganization
Primary Taxonomy207RC0000X
Legal Business NameGREENVILLE RANCHERIA
Location Address2638 EDITH AVERedding, CA 96001-3043
Mailing Address2638 Edith AveRedding, CA 96001-3043 · (530) 244-7192 · Fax (530) 244-4185
Phone(530) 244-7192
Fax(530) 244-4185
Organization SubpartNo
Authorized OfficialAntonia Louise HayworthBilling Supervisor · (530) 528-8600
Enumeration DateOctober 9, 2025
NPPES CertifiedOctober 9, 2025
✔ NPI 1013882877 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

2638 EDITH AVE, Redding, CA 96001
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0914600

Greenville Rancheria · Red Bluff, CA
Active · expires Jul 31, 2027
CLIA Number05D0914600
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateAugust 1, 2025
Certificate Expiration DateJuly 31, 2027
Laboratory DirectorDr. Ntango D. Banani
Laboratory Phone(530) 528-8600
Laboratory LocationGreenville Rancheria1425 Montgomery Road, Red Bluff, CA 96080
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT A. PICK, D.O., INC.
Internal Medicine (Cardiovascular Disease)
2638 EDITH AVE
REDDING, CA 96001
Shasta County (530) 244-7192
ROY V. DITCHEY, M.D., INC.
Internal Medicine (Cardiovascular Disease)
2638 EDITH AVE
REDDING, CA 96001
Shasta County (530) 244-7192
ROY V DITCHEY M.D.
Internal Medicine (Cardiovascular Disease)
2638 EDITH AVE
REDDING, CA 96001
Shasta County (530) 244-7192
ROBERT A PICK D.O.
Internal Medicine (Cardiovascular Disease)
2638 EDITH AVE
REDDING, CA 96001
Shasta County (530) 244-7192

Frequently Asked Questions

What is GREENVILLE RANCHERIA's NPI number?

The NPI number assigned to this healthcare provider is 1013882877, enumerated as an "organization" on October 09, 2025.

Where is the provider located?

The provider is located at 2638 EDITH AVE REDDING, CA 96001 and the phone number is (530) 244-7192.

What is the provider's specialty?

Internal Medicine with taxonomy code 207RC0000X and a focus in Cardiovascular Disease.