Basic Information
| Provider Information | |||||||||
| NPI: | 1740413798 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUTTER BAY HOSPITALS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SUTTER WEST BAY HOSPITALS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 30 MARK WEST SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954031436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156007735 | ||||||||
| FaxNumber: | 4156007776 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MARK WEST SPRINGS ROAD | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954031707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075764331 | ||||||||
| FaxNumber: | 7075764318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5104507357 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | CA | N | Hospitals | General Acute Care Hospital | 282N00000X | 110000005 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP40291G | 05 | CA | MEDICAID | 032556 | 01 | CA | VACCINES FOR CHILDREN | OTHER | D876 | 01 | CA | PRESUMPTIVE ELIGIBILITY | OTHER | ZZR00291G | 05 | CA | MEDICAID |