MEDICARE: SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207K00000X	Allergy & Immunology Physician
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician
3	231H00000X	Audiologist
4	207Y00000X	Otolaryngology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP5499	OTHER	CA	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497758155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1111 EXPOSITION BLVD
Second Line	:	BLDG 700
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4300
Country	:	US
Telephone Number	:	916-736-3399
Fax Number	:	916-233-4171

Provider Business Practice Location Address
First Line	:	1111 EXPOSITION BLVD
Second Line	:	BLDG 700
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4300
Country	:	US
Telephone Number	:	916-736-6670
Fax Number	:	916-233-4171

Authorized Official
Title or Position	:	CFO
Name	:	MS. TERRI WEBER
Credential	:
Telephone Number	:	916-736-3399

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/23/2024

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Directions to “SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC ” Practice Location

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