MEDICARE: SACRAMENTO FAMILY MEDICAL CENTER

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	207Q00000X	Family Medicine Physician	0000015806	CA

General Provider Information

NPI Number	:	1629346242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO FAMILY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3441 MARYSVILLE BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-4512
Country	:	US
Telephone Number	:	916-563-7230
Fax Number	:	916-563-7229

Provider Business Practice Location Address
First Line	:	12417 FAIR OAKS BLVD
Second Line	:	#600
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2501
Country	:	US
Telephone Number	:	916-863-4016
Fax Number	:	916-863-4019

Authorized Official
Title or Position	:	BILLING
Name	:	MRS. JENNIFER DALLIE BLANKENSHIP
Credential	:
Telephone Number	:	916-563-7230

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	02/24/2012

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