Provider Demographics
NPI:1992939565
Name:SUTTER VALLEY MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER VALLEY MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SH VP, QUALITY, SAFETY AND PATIENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-384-7544
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:916-845-6975
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:480 PLUMAS BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5005
Practice Address - Country:US
Practice Address - Phone:530-749-3661
Practice Address - Fax:530-749-3497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-11
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058083Medicaid
CAGR0058089Medicaid
CAGR005808CMedicaid
CAGPT000170Medicaid
CAGR0058080Medicaid
CAGR0058082Medicaid
CAGR0058084Medicaid
CAGAU000350Medicaid
CAGR005808EMedicaid
CAGR0058086Medicaid
CAGR0058088Medicaid
CAGR005808AMedicaid
CAGRE000930Medicaid
CAGR005808EMedicaid