1700803418 NPI number — DIGNITY HEALTH MEDICAL FOUNDATION

Table of content: (NPI 1700803418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700803418 NPI number — DIGNITY HEALTH MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH MEDICAL FOUNDATION
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 MEDICAL GROUP, A SERVICE OF DIGNITY HEALTH MEDICAL FOUNDATION
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:
1700803418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-379-2840
Provider Business Mailing Address Fax Number:
916-859-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 Q ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-7058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-733-3397
Provider Business Practice Location Address Fax Number:
916-733-5385
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HYLEN
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-851-2559

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRE000270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ29477Z . This is a "BSCA - ALLERGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29475X . This is a "BSCA - GASTROENTEROLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29478Z . This is a "BSCA - GENERAL SURGERY" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0050150 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ29339Z . This is a "BSCA - PEDIATRICS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29468Z . This is a "BSCA - RHEUMATOLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ26345Z . This is a "BSCA - ENDOCRINOLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29336Z . This is a "BSCA - FAMILY PRACTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29478Z . This is a "BSCA - URGENT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GSD000840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ28115Z . This is a "BSCA - DOWNTOWN" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29337Z . This is a "BSCA - INTERNAL MEDICINE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ293383 . This is a "BSCA - OBGYN" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29474Z . This is a "BSCA - RADIOLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ29472Z . This is a "BSCA - UROLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: KVY . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 017940400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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