1346383338 NPI number — DIGNITY HEALTH

Table of content: (NPI 1346383338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346383338 NPI number — DIGNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH
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:
ST. MARY'S MEDICAL CENTER
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:
1346383338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 PROSPECT PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-861-1102
Provider Business Mailing Address Fax Number:
916-861-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 STANYAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94117-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-668-1000
Provider Business Practice Location Address Fax Number:
415-750-5899
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRETTNER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
415-750-5726

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  220000071 , 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: 01 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3810Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 721561126 . This is a "IRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: LTC55833F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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