Provider Demographics
NPI:1841294782
Name:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Entity type:Organization
Organization Name:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCAIL 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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:530-274-6350
Mailing Address - Fax:530-274-6747
Practice Address - Street 1:1155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5723
Practice Address - Country:US
Practice Address - Phone:530-274-6350
Practice Address - Fax:530-274-6747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-09
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000138251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057755-001OtherBLUE CROSS
5720703OtherKAISER
680106483959490047OtherWPS TRICARE
CAHA0006OtherALTA
CAHHA07755FMedicaid
ZZZ14789ZOtherBLUE SHIELD OF CA
CA4509OtherBLUE CROSS
=========OtherIRS
CA057755Medicare Oscar/Certification