Provider Demographics
| NPI: | 1184859894 |
|---|---|
| Name: | SUTTER VALLEY MEDICAL FOUNDATION |
| Entity Type: | Organization |
| Organization Name: | SUTTER VALLEY MEDICAL FOUNDATION |
| Other - Org Name: | SUTTER REGIONAL MEDICAL FOUNDATION |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | SARAH |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KREVANS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 916-286-6732 |
| Mailing Address - Street 1: | PO BOX 255228 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SACRAMENTO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 95865-5228 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 916-854-6975 |
| Mailing Address - Fax: | 916-854-6844 |
| Practice Address - Street 1: | 2720 LOW CT |
| Practice Address - Street 2: | |
| Practice Address - City: | FAIRFIELD |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94534-9771 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 707-428-2731 |
| Practice Address - Fax: | 707-428-2740 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SUTTER MEDICAL FOUNDATION |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2009-05-26 |
| Last Update Date: | 2015-11-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | GCT000421 | Medicaid | |
| CA | GCT000422 | Medicaid | |
| CA | GR005986B | Medicaid | |
| CA | GPT000953 | Medicaid | |
| CA | GR0059866 | Medicaid | |
| CA | GR005986A | Medicaid | |
| CA | GR005986C | Medicaid | |
| CA | D861 | Other | PRESUMPTIVE ELIGIBILITY |
| CA | GPT000950 | Medicaid | |
| CA | GR0059865 | Medicaid | |
| CA | IDTF00410 | Medicaid | |
| CA | GSD004290 | Medicaid | |
| CA | GR0059869 | Medicaid | |
| CA | GR005986B | Medicaid |
