Provider Demographics
NPI:1003678632
Name:WESTERN SIERRA MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:WESTERN SIERRA MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-802-2706
Mailing Address - Street 1:11720 EDUCATION ST STE 3
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2419
Mailing Address - Country:US
Mailing Address - Phone:530-537-3000
Mailing Address - Fax:530-217-6137
Practice Address - Street 1:11720 EDUCATION ST STE 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2419
Practice Address - Country:US
Practice Address - Phone:530-537-3000
Practice Address - Fax:530-217-6137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN SIERRA MEDICAL CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)