Provider Demographics
NPI:1487632055
Name:SUTTER BUTTES IMAGING MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SUTTER BUTTES IMAGING MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-671-8564
Mailing Address - Street 1:945 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4114
Mailing Address - Country:US
Mailing Address - Phone:530-671-8564
Mailing Address - Fax:530-671-8592
Practice Address - Street 1:945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4114
Practice Address - Country:US
Practice Address - Phone:530-671-8564
Practice Address - Fax:530-671-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ72933ZOtherMEDIARE ID
ZZZ72907ZOtherMEDICARE ID
CAZZZ72907ZMedicaid
CAZZZ72933ZMedicaid
CAF16229Medicare UPIN
CAZZZ72907ZMedicaid
CAG64177Medicare UPIN
CAE29234Medicare UPIN
CAH28152Medicare UPIN
CAH40455Medicare UPIN
CAI71892Medicare UPIN
CAZZZ72933ZMedicaid