MEDICARE: SIERRA NEVADA MEMORIAL-MINERS HOSPITAL

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	251E00000X	Home Health Agency	230000138	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057755-001	OTHER	CA	BLUE CROSS
2	5720703	OTHER		KAISER
3	680106483959490047	OTHER		WPS TRICARE
4	HA0006	OTHER	CA	ALTA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	ZZZ14789Z	OTHER		BLUE SHIELD OF CA
7	4509	OTHER	CA	BLUE CROSS
8	=========	OTHER		IRS

General Provider Information

NPI Number	:	1841294782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA NEVADA MEMORIAL-MINERS HOSPITAL

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:	530-274-6350
Fax Number	:	530-274-6747

Provider Business Practice Location Address
First Line	:	1155 E MAIN ST
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5723
Country	:	US
Telephone Number	:	530-274-6350
Fax Number	:	530-274-6747

Authorized Official
Title or Position	:	CHIEF FINANCAIL OFFICER
Name	:	CAROLYN CANADY
Credential	:
Telephone Number	:	530-274-6099

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/26/2023

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