Provider Demographics
NPI:1639101116
Name:SIERRA VISTA HOSPITAL, INC.
Entity Type:Organization
Organization Name:SIERRA VISTA HOSPITAL, INC.
Other - Org Name:SIERRA VISTA REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-546-7797
Mailing Address - Street 1:FILE 57445
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7445
Mailing Address - Country:US
Mailing Address - Phone:209-578-2513
Mailing Address - Fax:805-546-7892
Practice Address - Street 1:1010 MURRAY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-8800
Practice Address - Country:US
Practice Address - Phone:805-546-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000059282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
050506B000000OtherSECTION 1011
978127350OtherAETNA US HEALTHCARE
CAZZT40506FMedicaid
CAHSC30506FMedicaid
005873-0001OtherPACIFICARE OF CALIFORNIA
000436OtherHUMANA
050506OtherBC OF CALIFORNIA
ZZZA4002ZOtherBS OF CALIFORNIA
005873-0001OtherPACIFICARE OF CALIFORNIA