Provider Demographics
NPI:1770728677
Name:SIERRA MOUNTAIN MEDICAL GROUP
Entity type:Organization
Organization Name:SIERRA MOUNTAIN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:LOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-582-1212
Mailing Address - Street 1:10978 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0433
Mailing Address - Country:US
Mailing Address - Phone:530-582-1212
Mailing Address - Fax:530-587-4278
Practice Address - Street 1:10978 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0433
Practice Address - Country:US
Practice Address - Phone:530-582-1212
Practice Address - Fax:530-587-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC386870207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C386870OtherMEDICAL LICENSE NUMBER
AL9100190OtherDEA NUMBER
00C386870Medicare PIN