MEDICARE: SUTTER BAY HOSPITALS

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
1	275N00000X	Medicare Defined Swing Bed Hospital Unit	110000094	CA

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

General Provider Information

NPI Number	:	1598098642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER BAY HOSPITALS

Provider Business Mailing Address
First Line	:	PO BOX 742412
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-2412
Country	:	US
Telephone Number	:	415-600-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	5176 HILL RD E
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-262-5000
Fax Number	:	707-262-5003

Authorized Official
Title or Position	:	CFO
Name	:	JOHN B. GATES
Credential	:
Telephone Number	:	510-450-7357

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	01/20/2022

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Directions to “SUTTER BAY HOSPITALS ” Practice Location

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