=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699890905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIERRA RURAL PHYSICIANS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 09/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5189 HOSPITAL RD JOHN C. FREMONT HEALTHCARE DISTRICT
-----------------------------------------------------
City | MARIPOSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95338-9524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-966-3631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1048 UNION ST #4
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94133-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-440-3949
-----------------------------------------------------
Fax | 415-474-4054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH E. C. ROGERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-440-3949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | G63276
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------