Provider Demographics
NPI:1881861417
Name:SACRAMENTO RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SACRAMENTO RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:OWYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-363-4040
Mailing Address - Street 1:PO BOX 276010
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6010
Mailing Address - Country:US
Mailing Address - Phone:916-363-4040
Mailing Address - Fax:916-363-6715
Practice Address - Street 1:6501 COYLE AVENUE
Practice Address - Street 2:MERCY SAN JUAN HOSPITAL
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-537-5190
Practice Address - Fax:916-537-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79531ZOtherMEDI-CAL
ZZZ79531ZOtherBLUE SHIELD
ZZZ79531ZMedicare PIN