Healthcare Provider Details

I. General information

NPI: 1629059746
Provider Name (Legal Business Name): SUTTER CENTRAL VALLEY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

PO BOX 740152
LOS ANGELES CA
90074-0152
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 855-398-1633
  • Fax: 209-572-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0609849
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number030000061
License Number StateCA

VIII. Authorized Official

Name: JOHN GATES
Title or Position: CFO SHBA
Credential:
Phone: 510-450-7357