Provider Demographics
NPI:1629346242
Name:SACRAMENTO FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:SACRAMENTO FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DALLIE
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-563-7230
Mailing Address - Street 1:3441 MARYSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4512
Mailing Address - Country:US
Mailing Address - Phone:916-563-7230
Mailing Address - Fax:916-563-7229
Practice Address - Street 1:12417 FAIR OAKS BLVD
Practice Address - Street 2:#600
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2501
Practice Address - Country:US
Practice Address - Phone:916-863-4016
Practice Address - Fax:916-863-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000015806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty