Provider Demographics
NPI:1982678587
Name:SUTTER CENTRAL VALLEY HOSPITALS
Entity Type:Organization
Organization Name:SUTTER CENTRAL VALLEY HOSPITALS
Other - Org Name:MEMORIAL EMERGENCY PHYSICIANS ASSOCIATES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-572-7172
Mailing Address - Street 1:1800 COFFEE RD
Mailing Address - Street 2:SUITE 87
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2705
Mailing Address - Country:US
Mailing Address - Phone:209-569-7532
Mailing Address - Fax:209-569-7634
Practice Address - Street 1:1700 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2803
Practice Address - Country:US
Practice Address - Phone:209-569-7172
Practice Address - Fax:209-569-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP161014OtherGROUP ID CCS
CAGR0044240Medicaid
CAZZZ22061ZMedicare ID - Type UnspecifiedGROUP ID MEDICARE