Provider Demographics
NPI:1528202090
Name:SUTTER CENTRAL VALLEY HOSPITALS
Entity Type:Organization
Organization Name:SUTTER CENTRAL VALLEY HOSPITALS
Other - Org Name:MEMORIAL HOSPITAL LOS BANOS/RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO VPBA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7357
Mailing Address - Street 1:PO BOX 740152
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0152
Mailing Address - Country:US
Mailing Address - Phone:855-398-1633
Mailing Address - Fax:209-569-7417
Practice Address - Street 1:400 W I ST STE C
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3459
Practice Address - Country:US
Practice Address - Phone:209-710-6333
Practice Address - Fax:209-827-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000177261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA553998Medicare Oscar/Certification
55-3998Medicare PIN