Provider Demographics
NPI:1093953523
Name:SUTTER HEALTH SHARED LABORATORY
Entity Type:Organization
Organization Name:SUTTER HEALTH SHARED LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-286-6731
Mailing Address - Street 1:2950 COLLIER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9224
Mailing Address - Country:US
Mailing Address - Phone:925-371-3800
Mailing Address - Fax:925-371-3810
Practice Address - Street 1:2950 COLLIER CANYON RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9224
Practice Address - Country:US
Practice Address - Phone:925-371-3800
Practice Address - Fax:925-371-3810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH SHARED LABORATORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-21
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF265291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory