1427181007 NPI number — DIGNITY HEALTH

Table of content: (NPI 1427181007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427181007 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:
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:
1427181007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 SOQUEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95065-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-462-7501
Provider Business Mailing Address Fax Number:
831-462-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 SOQUEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95065-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-462-7501
Provider Business Practice Location Address Fax Number:
831-462-7555
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALSH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
831-462-7504

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  070000030 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 070000030 , 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: 070000030 , 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: 721561119950650000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSP40242F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40242G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC00242F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSM00242F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00242G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721561119 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZA4401Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 721561119950650002 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 44BU . This is a "SANTA CRUZ COUNTY - PES ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC00242G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00242F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72156111995065A003 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSM00242G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721561119950650003 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC00242F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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