Provider Demographics
NPI:1003941808
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:MERCYCLINIC NORWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-453-4459
Mailing Address - Street 1:3911 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-3361
Mailing Address - Country:US
Mailing Address - Phone:916-929-8575
Mailing Address - Fax:916-929-3548
Practice Address - Street 1:3911 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3361
Practice Address - Country:US
Practice Address - Phone:916-929-8575
Practice Address - Fax:916-929-3548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000062261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
680483801OtherIRS
CAGR0091670Medicaid
CAHSP40017GMedicaid
942761692OtherIRS
CAGR0091670Medicaid
CA050017Medicare Oscar/Certification
CAZZZ19450ZMedicare PIN