Provider Demographics
NPI:1306902804
Name:SOLANO REGIONAL MEDICAL GROU
Entity type:Organization
Organization Name:SOLANO REGIONAL MEDICAL GROU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUSHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-434-2049
Mailing Address - Street 1:PO BOX 255668
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5668
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:770 MASON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4646
Practice Address - Country:US
Practice Address - Phone:707-454-5800
Practice Address - Fax:707-454-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4583680003Medicare NSC