Basic Information
| Provider Information | |||||||||
| NPI: | 1912351958 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUTTER VALLEY HOSPITALS | ||||||||
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| OtherOrganizationName: | MEMORIAL MEDICAL CENTER OPT PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 GATEWAY OAKS DR | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958334337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168877040 | ||||||||
| FaxNumber: | 9168877041 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 COFFEE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095697642 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | TERRA | ||||||||
| AuthorizedOfficialFirstName: | PAIGE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9168877050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336H0001X | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 251F00000X | N | Agencies | Home Infusion | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.