MEDICARE: SUTTER HEALTH SACRAMENTO SIERRA REGION

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	030000102	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619927449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER HEALTH SACRAMENTO SIERRA REGION

Provider Business Mailing Address
First Line	:	PO BOX 160100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-0100
Country	:	US
Telephone Number	:	800-353-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 S LAND PARK DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3612
Country	:	US
Telephone Number	:	800-353-3369
Fax Number	:

Authorized Official
Title or Position	:	CBO DIRECTOR
Name	:	MARGIE SOUZA
Credential	:
Telephone Number	:	916-978-8701

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/07/2022

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