1952634008 NPI number — SUTTER BAY HOSPITALS

Table of content: (NPI 1952634008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952634008 NPI number — SUTTER BAY HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER BAY HOSPITALS
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 WEST BAY HOSPITALS
Provider Other Organization Name Type Code:
4
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:
1952634008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742412
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:
90074-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-600-6000
Provider Business Mailing Address Fax Number:
415-600-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5176 HILL RD. E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-600-6000
Provider Business Practice Location Address Fax Number:
415-600-7776
Provider Enumeration Date:
09/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GATES
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
510-450-7357

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  110000094 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X , 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: HSP40476F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00476F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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