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General NPI Number Information
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NPI Number | 1033100854
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Entity Type | Organization
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Legal Business Name | SONORA COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 19747 GREENLEY RD SUITE S-2
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City | SONORA
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State | CA
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Zip | 95370-5998
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Country | US
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Telephone | 209-536-2665
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Fax | 209-533-7696
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Provider Business Mailing Address
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Address Line | 1000 GREENLEY RD
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City | SONORA
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State | CA
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Zip | 95370-5200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY D. MCCULLOCH
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Credential |
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Telephone | 209-536-5019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 030000094
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License Number State | CA
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