Provider Demographics
NPI:1831467653
Name:SUTTER VALLEY MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER VALLEY MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SH VP, QUALITY, SAFETY AND PATIENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-384-7544
Mailing Address - Street 1:P.O. BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:866-681-0736
Mailing Address - Fax:916-454-6987
Practice Address - Street 1:9279 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CA
Practice Address - Zip Code:95669
Practice Address - Country:US
Practice Address - Phone:209-245-6968
Practice Address - Fax:209-245-5135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058969Medicare Oscar/Certification