1275679797 NPI number — PRIMARY CARE PHCY

Table of content: (NPI 1275679797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275679797 NPI number — PRIMARY CARE PHCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE PHCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SACRAMENTO COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275679797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 BROADWAY
Provider Second Line Business Mailing Address:
STE 1500
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95820-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-874-9220
Provider Business Mailing Address Fax Number:
916-874-9409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 BROADWAY
Provider Second Line Business Practice Location Address:
STE 1500
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95820-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-874-9220
Provider Business Practice Location Address Fax Number:
916-874-9409
Provider Enumeration Date:
01/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY DIR
Authorized Official Telephone Number:
916-874-9299

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: PHE46273 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA348160 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2062396 . This is a "PK" identifier . This identifiers is of the category "OTHER".