1205055886 NPI number — COUNTY OF AMADOR

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 1205055886 NPI number — COUNTY OF AMADOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF AMADOR
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:
Provider Other Organization Name Type Code:
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:
1205055886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10877 CONDUCTOR BLVD STE 300
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:
95685-9688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-223-6412
Provider Business Mailing Address Fax Number:
209-223-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10877 CONDUCTOR BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SUTTER CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-223-6412
Provider Business Practice Location Address Fax Number:
209-223-0920
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRANFILL
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
209-223-6412

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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