Provider Demographics
NPI:1104954775
Name:SUTTER REGIONAL MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER REGIONAL MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:APPENZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-428-2731
Mailing Address - Street 1:PO BOX 254978
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-4978
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:770 MASON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4646
Practice Address - Country:US
Practice Address - Phone:707-454-5869
Practice Address - Fax:707-454-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ32310ZMedicare ID - Type Unspecified