Provider Demographics
NPI:1215225982
Name:SIERRA SPECIALTY CALL GROUP MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SIERRA SPECIALTY CALL GROUP MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-532-5244
Mailing Address - Street 1:680 GUZZI LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5288
Mailing Address - Country:US
Mailing Address - Phone:209-532-5244
Mailing Address - Fax:209-532-5247
Practice Address - Street 1:680 GUZZI LN
Practice Address - Street 2:SUITE 203
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5288
Practice Address - Country:US
Practice Address - Phone:209-532-5244
Practice Address - Fax:209-532-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10879207X00000X
CAA88661207X00000X
CAC37479207X00000X
CAA45369207X00000X, 208800000X
CAA53424208600000X
CAA50509208600000X
208800000X
CA12677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty