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General NPI Number Information
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NPI Number | 1063407229
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Entity Type | Organization
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Legal Business Name | SUTTER LAKESIDE HOSPITAL
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 5176 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-262-5181
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Fax | 707-262-5006
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Provider Business Mailing Address
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Address Line | 5176 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-262-5181
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Fax | 707-262-5006
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Authorized Official
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Title or Position | CEO
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Name | MRS. KELLY MATHER
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Credential | CEO
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Telephone | 707-262-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 010000118
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License Number State | CA
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