Provider Demographics
NPI:1104059153
Name:SUTTER BAY HOSPITALS
Entity type:Organization
Organization Name:SUTTER BAY HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7357
Mailing Address - Street 1:PO BOX 742412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2412
Mailing Address - Country:US
Mailing Address - Phone:855-398-1633
Mailing Address - Fax:415-600-7776
Practice Address - Street 1:180 ROWLAND WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5009
Practice Address - Country:US
Practice Address - Phone:415-600-7776
Practice Address - Fax:415-600-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
CA110000375282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC00131GMedicaid
CAHSP40131GMedicaid
CAZZR00131GMedicaid
CACGP143090Medicaid
CAD884OtherPRESUMPTIVE ELIGIBILITY
CAHS00131GMedicaid
050131Medicare Oscar/Certification
CAD884OtherPRESUMPTIVE ELIGIBILITY
05-0131Medicare PIN
CAZZR00131GMedicaid