1528199502 NPI number — DIGNITY HEALTH

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528199502 NPI number — DIGNITY HEALTH

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 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:

1528199502

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

09/20/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

14500 SHERMAN CIR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

VAN NUYS

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

91405-3052

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

818-885-8500

Provider Business Practice Location Address Fax Number:

818-885-5439

Provider Enumeration Date:

03/08/2007

Authorized Official Last Name:

TAYLOR

Authorized Official First Name:

MICHAEL

Authorized Official Middle Name:

Authorized Official Title or Position:

CHIEF FINANCIAL OFFICER

Authorized Official Telephone Number:

818-885-5321

• Taxonomy code: 273R00000X , with the licence number:  930000169 , 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: 930000169 , 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: 930000169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: ZZT40299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: HSC30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 870692259914050000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: LTC70143F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: NOHS . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: HSM30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: ZZT30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: ZZZA1962Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 0777367 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 870692259 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".