Provider Demographics
NPI:1306853296
Name:SUTTER COAST HOSPITAL
Entity Type:Organization
Organization Name:SUTTER COAST HOSPITAL
Other - Org Name:SUTTER COAST HEALTH CLINIC @ BROOKINGS-HARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-464-8880
Mailing Address - Street 1:800 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8359
Mailing Address - Country:US
Mailing Address - Phone:707-464-8511
Mailing Address - Fax:707-464-8886
Practice Address - Street 1:555 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9730
Practice Address - Country:US
Practice Address - Phone:541-469-9205
Practice Address - Fax:541-469-9204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER COAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840162000OtherBX REGENCE
OR227691Medicaid
CT3220OtherRAILROAD RETIRE
OR840162000OtherBX REGENCE