Provider Demographics
NPI:1740413798
Name:SUTTER BAY HOSPITALS
Entity Type:Organization
Organization Name:SUTTER BAY HOSPITALS
Other - Org Name:SUTTER WEST BAY HOSPITALS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7357
Mailing Address - Street 1:30 MARK WEST SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1436
Mailing Address - Country:US
Mailing Address - Phone:415-600-7735
Mailing Address - Fax:415-600-7776
Practice Address - Street 1:30 MARK WEST SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1707
Practice Address - Country:US
Practice Address - Phone:707-576-4331
Practice Address - Fax:707-576-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000005282N00000X
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40291GMedicaid
CA032556OtherVACCINES FOR CHILDREN
CAD876OtherPRESUMPTIVE ELIGIBILITY
CAZZR00291GMedicaid
CAZZR00291GMedicaid
CAHSP40291GMedicaid
050291Medicare Oscar/Certification
CA050291Medicare Oscar/Certification