1740359330 NPI number — SUTTER VALLEY MEDICAL FOUNDATION

Table of content: (NPI 1740359330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740359330 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:
1740359330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
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:
800-470-0071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1970 LAKE BLVD
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-5663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-792-2820
Provider Business Practice Location Address Fax Number:
530-792-2828
Provider Enumeration Date:
11/07/2006

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, PATIENT EDU
Authorized Official Telephone Number:
916-384-7544

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 375540046 . This is a "MEDICARE DME" identifier . This identifiers is of the category "OTHER".




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