Provider Demographics
NPI:1366513061
Name:COUNTY OF SACRAMENTO
Entity type:Organization
Organization Name:COUNTY OF SACRAMENTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-874-9919
Mailing Address - Street 1:4600 BROADWAY
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820
Mailing Address - Country:US
Mailing Address - Phone:916-875-5701
Mailing Address - Fax:916-854-9612
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-874-9670
Practice Address - Fax:916-875-6366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SACRAMENTO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology