Healthcare Provider Details

I. General information

NPI: 1699946574
Provider Name (Legal Business Name): SACRAMENTO RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 RAMOS CIR
SACRAMENTO CA
95827-2516
US

IV. Provider business mailing address

PO BOX 276010
SACRAMENTO CA
95827-6010
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-4040
  • Fax:
Mailing address:
  • Phone: 916-363-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY MATTHEWS
Title or Position: ADMIN ASSOCITATE
Credential:
Phone: 916-363-4040