MEDICARE: SUTTER COMMUNITY HEALTH

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	261QP2300X	Primary Care Clinic/Center	550000581	CA
2	3336C0002X	Clinic Pharmacy	DEA #FE0575122	CA
3	261QF0050X	Non-Surgical Family Planning Clinic/Center	550000581	CA
4	291U00000X	Clinical Medical Laboratory	05D0942632 CLP322959	CA
5	261QC1500X	Community Health Clinic/Center	550000581	CA
6	3336C0002X	Clinic Pharmacy	BD OF PHARMACY #1822	CA
7	261Q00000X	Clinic/Center	550000581	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D585	OTHER	CA	MEDI-CAL PRESUMPTIVE ELIG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811021405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	350 30TH ST STE 205
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-3425
Country	:	US
Telephone Number	:	510-869-8425
Fax Number	:	510-506-7710

Provider Business Practice Location Address
First Line	:	350 30TH ST
Second Line	:	STE 205
City	:	OAKLAND
State	:	CA
Zip	:	94609-3425
Country	:	US
Telephone Number	:	510-869-8425
Fax Number	:	510-506-7710

Authorized Official
Title or Position	:	ADMINISTRATIVE MEDICAL DIRECTOR
Name	:	ANGELYN THOMAS
Credential	:
Telephone Number	:	510-869-8425

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/16/2026

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Directions to “SUTTER COMMUNITY HEALTH ” Practice Location

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