MEDICARE: SAC HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	EAP70708F	OTHER	CA	EAPC
3	ENVOY3000	OTHER	CA	ENVOY SITE ID

General Provider Information

NPI Number	:	1386299204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAC HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	250 S G ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410-3320
Country	:	US
Telephone Number	:	909-382-7100
Fax Number	:	909-382-7101

Provider Business Practice Location Address
First Line	:	84110 MANILA AVE # B
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-7128
Country	:	US
Telephone Number	:	909-382-7100
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	TASHA AMICK
Credential	:
Telephone Number	:	909-382-7100

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	04/21/2025

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Directions to “SAC HEALTH SYSTEM ” Practice Location

Language	Start Address	Practice Location

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