Provider Demographics
NPI:1720401284
Name:SACSOLANO ANESTHESIA EXCHANGE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SACSOLANO ANESTHESIA EXCHANGE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:916-481-6800
Mailing Address - Street 1:PO BOX 660910
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-0910
Mailing Address - Country:US
Mailing Address - Phone:916-481-6800
Mailing Address - Fax:916-481-1881
Practice Address - Street 1:3315 WATT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3600
Practice Address - Country:US
Practice Address - Phone:916-481-6800
Practice Address - Fax:916-481-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty