1356389878 NPI number — DIGNITY HEALTH

Table of content: (NPI 1356389878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356389878 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:
MERCY HOSPITAL OF FOLSOM
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:
1356389878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2013
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:
1650 CREEKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-983-7400
Provider Business Practice Location Address Fax Number:
916-983-7406
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGNESS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-984-7379

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  030000372 , 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: HSP00414H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40414H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC00414H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC3408Z . This is a "BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942761692956300000 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 196456500 . This is a "DEPT. OF LABOR - WC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 942761692 . This is a "IRS - PRE-MERGER TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: CGP008385 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com