Provider Demographics
NPI:1700960267
Name:SUTTER COAST HOSPITAL
Entity Type:Organization
Organization Name:SUTTER COAST HOSPITAL
Other - Org Name:SUTTER COAST COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-464-8880
Mailing Address - Street 1:800 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8359
Mailing Address - Country:US
Mailing Address - Phone:707-464-8511
Mailing Address - Fax:707-464-8886
Practice Address - Street 1:780 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-6715
Practice Address - Fax:707-465-0870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER COAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare ID - Type Unspecified
CAPENDINGMedicaid