1669523643 NPI number — DIGNITY HEALTH

Table of content: (NPI 1669523643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669523643 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:
SAN GABRIEL VALLEY 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:
1669523643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2013
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:
438 W LAS TUNAS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91776-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-943-3775
Provider Business Practice Location Address Fax Number:
626-299-3192
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
616-570-6655

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  930000041 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 930000041 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LTC70144F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30132G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 651191366917760000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LTC55237H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA2013Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT40132G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SGVM . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050132B000000 . This is a "CMS SECTION 1011" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30132G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2065802 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 651191366 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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