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NPI Code Detail

MEDICARE: SAC HEALTH SYSTEM

MEDICARE: SAC HEALTH SYSTEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/CenterCMM70708FCA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)CMM70708FCA
3261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EAP70708FOTHERCAEAPC
2ENVOY3000OTHERCAENVOY SITE ID
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013935915
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAC HEALTH SYSTEM
Provider Business Mailing Address
First Line : 1454 E 2ND ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-0118
Country : US
Telephone Number : 909-382-7100
Fax Number : 909-382-7101
Provider Business Practice Location Address
First Line : 1454 E 2ND ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-0118
Country : US
Telephone Number : 909-382-7100
Fax Number : 909-382-7136
Authorized Official
Title or Position : DIR. OF BILLING
Name : TASHA AMICK
Credential :
Telephone Number : 909-382-7100
Provider Enumeration Date : 07/18/2006
Last Update Date : 04/21/2025

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Directions to “SAC HEALTH SYSTEM ” Practice Location

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