Provider Demographics
NPI:1568590636
Name:SUTTER NORTH MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER NORTH MEDICAL FOUNDATION
Other - Org Name:SUTTER NORTH ANESTHESIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-749-3330
Mailing Address - Street 1:969 PLUMAS ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 PLUMAS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5005
Practice Address - Country:US
Practice Address - Phone:530-749-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058085Medicaid
CAGR0058085Medicaid