MEDICARE: SACRAMENTO FAMILY MEDICAL CLINIC

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	207Q00000X	Family Medicine Physician	132640	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	:	1508974031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO FAMILY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	3441 MARYSVILLE BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-4512
Country	:	US
Telephone Number	:	916-563-7230
Fax Number	:	916-563-7229

Provider Business Practice Location Address
First Line	:	4241 FLORIN RD
Second Line	:	SUITE 30
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2535
Country	:	US
Telephone Number	:	916-427-1227
Fax Number	:	916-427-6325

Authorized Official
Title or Position	:	OWNER
Name	:	GILBERT SIMON
Credential	:	MD
Telephone Number	:	916-563-7230

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	05/14/2013

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Directions to “SACRAMENTO FAMILY MEDICAL CLINIC ” Practice Location

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