Basic Information
Provider Information | |||||||||
NPI: | 1316061997 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAINT FRANCIS MEMORIAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3215 PROSPECT PARK DR | ||||||||
Address2: |   | ||||||||
City: | RANCHO CORDOVA | ||||||||
State: | CA | ||||||||
PostalCode: | 956706017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9168611102 | ||||||||
FaxNumber: | 9168617707 | ||||||||
Practice Location | |||||||||
Address1: | 900 HYDE ST | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941094806 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4153536000 | ||||||||
FaxNumber: | 4153536912 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/19/2007 | ||||||||
LastUpdateDate: | 09/09/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FOX | ||||||||
AuthorizedOfficialFirstName: | ALAN | ||||||||
AuthorizedOfficialMiddleName: | E. | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 4153536635 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 220000069 | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 01 | 01 |   | KAISER | OTHER | HSC00152F | 05 | CA |   | MEDICAID | ZZZA3807Z | 01 | CA | BLUE SHIELD | OTHER | LAB93789F | 05 | CA |   | MEDICAID | HSP40152F | 05 | CA |   | MEDICAID | ZZR00152F | 05 | CA |   | MEDICAID |