Provider Demographics
NPI:1821089749
Name:SONORA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:SONORA COMMUNITY HOSPITAL
Other - Org Name:ANGELS CAMP FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-536-5011
Mailing Address - Street 1:14542 LOLLY LN
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9226
Mailing Address - Country:US
Mailing Address - Phone:209-536-2760
Mailing Address - Fax:209-533-7696
Practice Address - Street 1:445 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222
Practice Address - Country:US
Practice Address - Phone:209-736-0249
Practice Address - Fax:209-533-7696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONORA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-31
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ52950ZOtherBLUE CROSS/BLUE SHIELD
CACU0092Medicare PIN
CA050335Medicare Oscar/Certification
CA050335Medicare PIN
CAZZZ52950ZOtherBLUE CROSS/BLUE SHIELD