Provider Demographics
NPI:1356779797
Name:SUTTER BAY HOSPITALS
Entity type:Organization
Organization Name:SUTTER BAY HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2000 POWELL ST. 10TH FL
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1804
Mailing Address - Country:US
Mailing Address - Phone:510-450-7347
Mailing Address - Fax:510-450-7309
Practice Address - Street 1:5196 HILL RD E
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6360
Practice Address - Country:US
Practice Address - Phone:707-263-6885
Practice Address - Fax:707-263-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058980Medicare Oscar/Certification
CACN645AMedicare PIN