MEDICARE: SUTTER NORTH MEDICAL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	230000331	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134159841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER NORTH MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 609
Second Line	:
City	:	BROWNSVILLE
State	:	CA
Zip	:	95919-0609
Country	:	US
Telephone Number	:	530-675-2457
Fax Number	:	530-675-0530

Provider Business Practice Location Address
First Line	:	16911 WILLOW GLEN RD
Second Line	:
City	:	BROWNSVILLE
State	:	CA
Zip	:	95919-9707
Country	:	US
Telephone Number	:	530-675-2457
Fax Number	:	530-675-0530

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. DAVID YAMAMOTO
Credential	:
Telephone Number	:	530-749-3330

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/24/2008

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Directions to “SUTTER NORTH MEDICAL FOUNDATION ” Practice Location

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