Provider Demographics
NPI:1659697845
Name:UC DAVIS MEDICAL CENTER
Entity Type:Organization
Organization Name:UC DAVIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF OTOLARYNGOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-2801
Mailing Address - Street 1:2521 STOCKTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:916-734-2801
Mailing Address - Fax:916-703-5011
Practice Address - Street 1:2521 STOCKTON BLVD.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826
Practice Address - Country:US
Practice Address - Phone:916-734-2801
Practice Address - Fax:916-703-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital