Healthcare Provider Details

I. General information

NPI: 1629301775
Provider Name (Legal Business Name): SUTTER WEST BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OLD LUCERNE ROAD
UPPER LAKE CA
95485-0000
US

IV. Provider business mailing address

PO BOX 742412
LOS ANGELES CA
90074-2412
US

V. Phone/Fax

Practice location:
  • Phone: 707-275-9066
  • Fax: 707-275-9070
Mailing address:
  • Phone: 415-600-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number110000094
License Number StateCA

VIII. Authorized Official

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