Provider Demographics
NPI:1457593980
Name:SUTTER VALLEY MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER VALLEY MEDICAL FOUNDATION
Other - Org Name:SUTTER NORTH SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SH VP, QUALITY, SAFETY AND PATIENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-384-7544
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:460 PLUMAS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5005
Practice Address - Country:US
Practice Address - Phone:530-749-5500
Practice Address - Fax:530-749-5520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-30
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
CA05D0919786291U00000X
CA05D1041437291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01734FMedicaid
CASUR01359FMedicaid
ZZZ31855ZMedicare PIN
F1734Medicare PIN
CASUR01734FMedicaid