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General NPI Number Information
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NPI Number | 1699449496
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Entity Type | Organization
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Legal Business Name | SAC HEALTH SYSTEM
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 801 E MOUNTAIN VIEW ST
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City | BARSTOW
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State | CA
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Zip | 92311-3053
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Country | US
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Telephone | 909-382-7100
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Fax | 909-382-7101
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Provider Business Mailing Address
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Address Line | 250 S G ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3320
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Country | US
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Telephone | 909-382-7100
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Fax | 909-382-7101
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | TASHA AMICK
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Credential |
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Telephone | 909-382-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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