Provider Demographics
NPI:1427181007
Name:DIGNITY HEALTH
Entity Type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:DOMINICAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-462-7504
Mailing Address - Street 1:1555 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1705
Mailing Address - Country:US
Mailing Address - Phone:831-462-7501
Mailing Address - Fax:831-462-7555
Practice Address - Street 1:1555 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1705
Practice Address - Country:US
Practice Address - Phone:831-462-7501
Practice Address - Fax:831-462-7555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000030273Y00000X, 282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA721561119950650000OtherWPS TRICARE
CAHSP40242FMedicaid
CAHSP40242GMedicaid
CALTC00242FMedicaid
CAHSM00242FMedicaid
CAZZR00242GMedicaid
CA721561119OtherIRS
CAZZZA4401ZOtherBLUE SHIELD
CA721561119950650002OtherWPS TRICARE
44BUOtherSANTA CRUZ COUNTY - PES ID
CAHSC00242GMedicaid
CAZZR00242FMedicaid
CA72156111995065A003OtherWPS TRICARE
CAHSM00242GMedicaid
CA721561119950650003OtherWPS TRICARE
CAHSC00242FMedicaid
CA721561119950650002OtherWPS TRICARE
CA050242Medicare Oscar/Certification
CAZZZA4401ZOtherBLUE SHIELD
CAHSM00242FMedicaid