Provider Demographics
NPI:1457393639
Name:WESTERN SIERRA ORTHOPAEDIC CENTER INC
Entity Type:Organization
Organization Name:WESTERN SIERRA ORTHOPAEDIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-344-2070
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-344-2070
Mailing Address - Fax:530-295-0400
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2070
Practice Address - Fax:530-295-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50528207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100840Medicaid
CAGR0100840Medicaid
CA5608010001Medicare NSC