Provider Demographics
NPI:1558495937
Name:DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:DIGNITY HEALTH MEDICAL FOUNDATION
Other - Org Name:MERCY MEDICAL GROUP, A SERVICE OF DIGNITY HEALTH MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE #72938
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-2938
Mailing Address - Country:US
Mailing Address - Phone:916-733-3397
Mailing Address - Fax:
Practice Address - Street 1:7911 LAGUNA BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7920
Practice Address - Country:US
Practice Address - Phone:916-733-5801
Practice Address - Fax:916-683-0232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0019838OtherCIGNA
KYZOtherBLUE CROSS
341996544OtherSPECIAL PURPOSE TAX ID #
ZZZ09972ZOtherBLUE SHIELD
983OtherHEALTH NET
195OtherHEALTH NET
CAGR006356BMedicaid
CAGR006356BMedicaid