Provider Demographics
NPI:1801502679
Name:SIERRA MEDICAL PARTNERSHIP
Entity type:Organization
Organization Name:SIERRA MEDICAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-663-2100
Mailing Address - Street 1:1625 CREEKSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3819
Mailing Address - Country:US
Mailing Address - Phone:916-663-2100
Mailing Address - Fax:
Practice Address - Street 1:6620 COYLE AVE STE 408
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6338
Practice Address - Country:US
Practice Address - Phone:916-857-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty