Basic Information
| Provider Information | |||||||||
| NPI: | 1366619967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO RADIOLOGY MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 276010 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958276010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163634040 | ||||||||
| FaxNumber: | 9163636715 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 HOSPITAL DRIVE | ||||||||
| Address2: | METHODIST HOSPITAL | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164236176 | ||||||||
| FaxNumber: | 9164235956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | OWYANG | ||||||||
| AuthorizedOfficialFirstName: | SIGRID | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9163634040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | GR001137F | 01 | CA | MEDI-CAL | OTHER | ZZZ43878Z | 01 | BLUE SHIELD | OTHER |