1477671535 NPI number — DIGNITY HEALTH

Table of content: (NPI 1477671535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477671535 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:
MERCY MEDICAL CENTER REDDING
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:
1477671535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 496009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96049-6009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-225-6300
Provider Business Mailing Address Fax Number:
530-225-7278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2175 ROSALINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-225-6300
Provider Business Practice Location Address Fax Number:
530-225-7278
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
530-225-6121

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  230000024 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56236041196001B001 . This is a "CHAMPUS TRICARE MATERNITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0030730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP166510 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 562360411960010000 . This is a "CHAMPUS TRICARE ACUTE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZC4504Z . This is a "BLUE SHIELD OF CA ACUTE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ56416Z . This is a "BLUE SHIELD CA MATERNITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ94524Z . This is a "BLUE SHIELD CA AMBULANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZC4504Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 562360411 . This is a "IRS FTN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZR00280G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ56417Z . This is a "BLUE SHIELD CA FAMILY HTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050280B000000 . This is a "CMS SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 562360411960010002 . This is a "CHAMPUS TRICARE AMBULANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 56236041196001A001 . This is a "CHAMPUS TRICARE FAMILY HH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: GR0040290 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40280G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MTE00180F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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