Basic Information
| Provider Information | |||||||||
| NPI: | 1932148947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER VALLEY HOSPITALS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUTTER MEDICAL CENTER SACRAMENTO LABORATORY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 L ST. STRE 700 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167338306 | ||||||||
| FaxNumber: | 9167338396 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 CAPITOL AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168871020 | ||||||||
| FaxNumber: | 9167338396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONFORTI | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9168877040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 05D0615620 | CA | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 1932148947 | 01 | CA | MEDI-CAL | OTHER |