Basic Information
| Provider Information | |||||||||
| NPI: | 1588756258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER EMERGENCY MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 12020 | ||||||||
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| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926852020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885565621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 COFFEE ROAD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095264500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | NATIONS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | KELLY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8885565621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | C42247 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0081865 | 05 | CA | MEDICAID |