1558495937 NPI number — DIGNITY HEALTH MEDICAL FOUNDATION

Table of content: (NPI 1558495937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558495937 NPI number — DIGNITY HEALTH MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH 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:
1558495937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000
Provider Second Line Business Mailing Address:
FILE #72938
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160-2938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-733-3397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7911 LAGUNA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-7920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-733-5801
Provider Business Practice Location Address Fax Number:
916-683-0232
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYLEN
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-851-2559

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0019838 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: KYZ . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341996544 . This is a "SPECIAL PURPOSE TAX ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ09972Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 983 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR006356B , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com