Basic Information
| Provider Information | |||||||||
| NPI: | 1629346242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO FAMILY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3441 MARYSVILLE BLVD | ||||||||
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| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958384512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165637230 | ||||||||
| FaxNumber: | 9165637229 | ||||||||
| Practice Location | |||||||||
| Address1: | 12417 FAIR OAKS BLVD | ||||||||
| Address2: | #600 | ||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956282501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168634016 | ||||||||
| FaxNumber: | 9168634019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2011 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | BLANKENSHIP | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | DALLIE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9165637230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0000015806 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.