MEDICARE: SUTTER WEST BAY MEDICAL FOUNDATION

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1811242563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER WEST BAY MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	2015 STEINER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2627
Country	:	US
Telephone Number	:	415-600-4280
Fax Number	:	415-600-2128

Provider Business Practice Location Address
First Line	:	1200 SONOMA AVE
Second Line	:	STE 2
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-6664
Country	:	US
Telephone Number	:	707-571-2192
Fax Number	:	707-571-2194

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL J. COHILL
Credential	:
Telephone Number	:	415-600-7771

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	08/01/2012

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