Provider Demographics
NPI:1720166705
Name:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Entity Type:Organization
Organization Name:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Other - Org Name:SIERRA NEVADA MATERNAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-274-6099
Mailing Address - Street 1:155 GLASSON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5723
Mailing Address - Country:US
Mailing Address - Phone:530-274-6000
Mailing Address - Fax:530-274-6234
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-274-6175
Practice Address - Fax:530-274-6234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000152261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP127135Medicaid
CAZZR00150FMedicaid
CAGR0051930Medicaid
ZZZC2905ZOtherBLUE SHIELD OF CA
CAHSP40150FMedicaid
=========959450000OtherWPS TRICARE
CAHSP40150FMedicaid
CA050150Medicare Oscar/Certification