Provider Demographics
NPI:1952634008
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:PO BOX 742412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2412
Mailing Address - Country:US
Mailing Address - Phone:415-600-6000
Mailing Address - Fax:415-600-7776
Practice Address - Street 1:5176 HILL RD. E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:415-600-6000
Practice Address - Fax:415-600-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000094282NC0060X
CA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40476FMedicaid
CAZZR00476FMedicaid
CAHSP40476FMedicaid
05-1329Medicare PIN
CAZZR00476FMedicaid
CACN645AMedicare Oscar/Certification
CA05-1329Medicare PIN