Basic Information
| Provider Information | |||||||||
| NPI: | 1841240454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO CARDIOVASCULAR SURGEONS MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 F ST | ||||||||
| Address2: | STE 111 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164528291 | ||||||||
| FaxNumber: | 9164521733 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 F ST | ||||||||
| Address2: | STE 111 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164528291 | ||||||||
| FaxNumber: | 9164521733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 09/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | LOESCHER | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9164515602 | ||||||||
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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 | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 208G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.