1184859894 NPI number — SUTTER VALLEY MEDICAL FOUNDATION

Table of content: (NPI 1184859894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184859894 NPI number — SUTTER VALLEY MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER VALLEY 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:
Provider Other Organization Name Type Code:
6
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:
1184859894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 255228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95865-5228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-854-6975
Provider Business Mailing Address Fax Number:
916-854-6844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 LOW CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94534-9771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-428-2731
Provider Business Practice Location Address Fax Number:
707-428-2740
Provider Enumeration Date:
05/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOPES
Authorized Official First Name:
KRISTA
Authorized Official Middle Name:
Authorized Official Title or Position:
SH VP, QUALITY, SAFETY AND PATIENT
Authorized Official Telephone Number:
916-384-7544

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GCT000422 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GPT000950 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GCT000421 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GPT000953 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GSD004290 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR005986A , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: IDTF00410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR005986B , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0059865 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0059869 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D861 . This is a "PRESUMPTIVE ELIGIBILITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0059866 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR005986C , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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