Provider Demographics
NPI: | 1558388504 |
---|---|
Name: | SUTTER REGIONAL MEDICAL FOUNDATION |
Entity Type: | Organization |
Organization Name: | SUTTER REGIONAL MEDICAL FOUNDATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CAROLYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | APPENZELLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 707-434-2049 |
Mailing Address - Street 1: | PO BOX 6080 |
Mailing Address - Street 2: | |
Mailing Address - City: | FAIRFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94533-0695 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2720 LOW COURT |
Practice Address - Street 2: | |
Practice Address - City: | FAIRFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94534-9727 |
Practice Address - Country: | US |
Practice Address - Phone: | 707-426-3911 |
Practice Address - Fax: | 707-436-2507 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-16 |
Last Update Date: | 2008-02-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR0059869 | Medicaid | |
ZZZ32231Z | Medicare ID - Type Unspecified |