Provider Demographics
NPI:1053628552
Name:SACRAMENTO ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:SACRAMENTO ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-434-0639
Mailing Address - Street 1:2301 INDIAN WELLS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4611
Mailing Address - Country:US
Mailing Address - Phone:575-434-0639
Mailing Address - Fax:575-434-4148
Practice Address - Street 1:2301 INDIAN WELLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4611
Practice Address - Country:US
Practice Address - Phone:575-434-0639
Practice Address - Fax:575-434-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD209-0724207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty