MEDICARE: SIERRA MANAGEMENT SERVICES INC.

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ621752	OTHER	CA	BLUE SHIELD NUMBER

General Provider Information

NPI Number	:	1912069568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA MANAGEMENT SERVICES INC.

Provider Business Mailing Address
First Line	:	1110 CIVIC CENTER BLVD
Second Line	:	# 502
City	:	YUBA CITY
State	:	CA
Zip	:	95993-3013
Country	:	US
Telephone Number	:	530-671-7977
Fax Number	:	530-671-6163

Provider Business Practice Location Address
First Line	:	1110 CIVIC CENTER BLVD
Second Line	:	# 502
City	:	YUBA CITY
State	:	CA
Zip	:	95993-3013
Country	:	US
Telephone Number	:	530-671-7977
Fax Number	:	530-671-6163

Authorized Official
Title or Position	:	CFO
Name	:	MRS. SIRI PRITAM KHALSA
Credential	:
Telephone Number	:	530-671-7770

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/07/2018

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