Healthcare Provider Details

I. General information

NPI: 1588756258
Provider Name (Legal Business Name): SUTTER EMERGENCY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE ROAD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

P.O. BOX 12020
WESTMINSTER CA
92685-2020
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 888-556-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC42247
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN KELLY NATIONS
Title or Position: PRESIDENT
Credential: MD
Phone: 888-556-5621