Provider Demographics
NPI:1700803418
Name:DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:DIGNITY HEALTH MEDICAL FOUNDATION
Other - Org Name:MERCY MEDICAL GROUP, A SERVICE OF DIGNITY HEALTH MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:PO BOX 742016
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2016
Mailing Address - Country:US
Mailing Address - Phone:916-379-2840
Mailing Address - Fax:916-859-1106
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3397
Practice Address - Fax:916-733-5385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE000270Medicaid
ZZZ29477ZOtherBSCA - ALLERGY
ZZZ29475XOtherBSCA - GASTROENTEROLOGY
ZZZ29478ZOtherBSCA - GENERAL SURGERY
CAGR0050150Medicaid
ZZZ29339ZOtherBSCA - PEDIATRICS
ZZZ29468ZOtherBSCA - RHEUMATOLOGY
ZZZ26345ZOtherBSCA - ENDOCRINOLOGY
ZZZ29336ZOtherBSCA - FAMILY PRACTICE
ZZZ29478ZOtherBSCA - URGENT CARE
CAGSD000840Medicaid
ZZZ28115ZOtherBSCA - DOWNTOWN
ZZZ29337ZOtherBSCA - INTERNAL MEDICINE
ZZZ293383OtherBSCA - OBGYN
ZZZ29474ZOtherBSCA - RADIOLOGY
ZZZ29472ZOtherBSCA - UROLOGY
CAKVYOtherBLUE CROSS
ZZZ29336ZOtherBSCA - FAMILY PRACTICE
ZZZ28115ZOtherBSCA - DOWNTOWN
ZZZ29468ZOtherBSCA - RHEUMATOLOGY