Healthcare Provider Details

I. General information

NPI: 1013187566
Provider Name (Legal Business Name): USCG AIRSTA SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

6037 PRICE AVE
MCCLELLAN CA
95652-2400
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER JOHN HARRIS
Title or Position: APA-C
Credential:
Phone: 916-561-7568