Healthcare Provider Details

I. General information

NPI: 1467487868
Provider Name (Legal Business Name): GALEN CHURCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EXPO PKWY STE 140
SACRAMENTO CA
95815-4239
US

IV. Provider business mailing address

PO BOX 161959
SACRAMENTO CA
95816-1959
US

V. Phone/Fax

Practice location:
  • Phone: 916-346-4219
  • Fax: 916-426-5757
Mailing address:
  • Phone: 916-346-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A8620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO213980
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8620
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO23047
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO23047
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number010514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: