Provider Demographics
NPI:1558538157
Name:SACRAMENTO RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SACRAMENTO RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:OWYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-363-4040
Mailing Address - Street 1:PO BOX 276010
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6010
Mailing Address - Country:US
Mailing Address - Phone:916-363-4040
Mailing Address - Fax:916-363-6715
Practice Address - Street 1:6305 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0438
Practice Address - Country:US
Practice Address - Phone:916-961-6920
Practice Address - Fax:916-966-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0011374OtherMEDI-CAL
YYY20432YOtherBLUE SHIELD
YYY20432YOtherBLUE SHIELD