Healthcare Provider Details

I. General information

NPI: 1003807066
Provider Name (Legal Business Name): SONORA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENLEY RD SUITE 911
SONORA CA
95370-5287
US

IV. Provider business mailing address

1000 GREENLEY RD
SONORA CA
95370-5200
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-0511
  • Fax: 209-533-7696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY D. MCCULLOCH
Title or Position: PRESIDENT
Credential:
Phone: 209-536-5019