Provider Demographics
NPI:1275805277
Name:SACRAMENTO MEDICAL GROUP
Entity Type:Organization
Organization Name:SACRAMENTO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:916-387-6929
Mailing Address - Street 1:15 BUSINESS PARK WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-0959
Mailing Address - Country:US
Mailing Address - Phone:916-387-6929
Mailing Address - Fax:916-387-6977
Practice Address - Street 1:2708 MERCANTILE DR.
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-0959
Practice Address - Country:US
Practice Address - Phone:916-387-6929
Practice Address - Fax:916-387-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty