Healthcare Provider Details

I. General information

NPI: 1043291164
Provider Name (Legal Business Name): SUTTER TRACY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N TRACY BLVD
TRACY CA
95376-3451
US

IV. Provider business mailing address

PO BOX 740152
LOS ANGELES CA
90074-0152
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-1500
  • Fax:
Mailing address:
  • Phone: 855-398-1633
  • Fax: 209-572-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number030000105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0300000105
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN TRENT HUNTER
Title or Position: VP SHARED SERVICES
Credential:
Phone: 916-297-8555