Provider Demographics
NPI:1700855756
Name:SUTTER MEDICAL CENTER OF SANTA ROSA
Entity Type:Organization
Organization Name:SUTTER MEDICAL CENTER OF SANTA ROSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-576-4203
Mailing Address - Street 1:3325 CHANATE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1707
Mailing Address - Country:US
Mailing Address - Phone:707-576-4000
Mailing Address - Fax:707-576-4318
Practice Address - Street 1:3325 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1707
Practice Address - Country:US
Practice Address - Phone:707-576-4000
Practice Address - Fax:707-576-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM00291GMedicaid
CAHSP40291GMedicaid
CAZZR00291GMedicaid
CAZZR00291GMedicaid