Provider Demographics
NPI:1619111416
Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Entity Type:Organization
Organization Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Other - Org Name:SUTTER AMADOR HEALTH CENTER - PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KREVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-286-6732
Mailing Address - Street 1:PO BOX 160100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-0100
Mailing Address - Country:US
Mailing Address - Phone:916-978-8873
Mailing Address - Fax:916-978-8870
Practice Address - Street 1:9279 LOCUST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CA
Practice Address - Zip Code:95669
Practice Address - Country:US
Practice Address - Phone:209-245-6968
Practice Address - Fax:209-256-5515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH SACRAMENTO SIERRA REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000008282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03970GMedicaid
058501Medicare Oscar/Certification