1841371937 NPI number — SUTTER CREEK OB ANESTHESIA SERVICES, A PROFESSIONAL NURSING CORPORATIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841371937 NPI number — SUTTER CREEK OB ANESTHESIA SERVICES, A PROFESSIONAL NURSING CORPORATIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER CREEK OB ANESTHESIA SERVICES, A PROFESSIONAL NURSING CORPORATIO
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:
SUTTER CREEK OB ANESTHESIA SERVICES
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:
1841371937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUTTER CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95685-0966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-270-0340
Provider Business Mailing Address Fax Number:
888-270-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 TIMBERLAKE WAY
Provider Second Line Business Practice Location Address:
METHODIST HOSPITAL
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-423-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCULLEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
888-270-0340

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ05546Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GRN000080 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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