Provider Demographics
NPI:1780463257
Name:SIERRA FAMILY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:SIERRA FAMILY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-292-3478
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-0995
Mailing Address - Country:US
Mailing Address - Phone:530-292-3478
Mailing Address - Fax:
Practice Address - Street 1:8676 MARYSVILLE RD
Practice Address - Street 2:
Practice Address - City:OREGON HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95962-9718
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)