1962493791 NPI number — SONORA COMMUNITY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962493791 NPI number — SONORA COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONORA COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROMPT CARE INDIAN ROCK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962493791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14542 LOLLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SONORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95370-9226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-536-2760
Provider Business Mailing Address Fax Number:
209-533-7696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14540 MONO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-8858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-532-3167
Provider Business Practice Location Address Fax Number:
209-533-7696
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JAHN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-536-5011

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ65514Z . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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