Provider Demographics
NPI:1134159841
Name:SUTTER NORTH MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SUTTER NORTH MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-749-3330
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95919-0609
Mailing Address - Country:US
Mailing Address - Phone:530-675-2457
Mailing Address - Fax:530-675-0530
Practice Address - Street 1:16911 WILLOW GLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95919-9707
Practice Address - Country:US
Practice Address - Phone:530-675-2457
Practice Address - Fax:530-675-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000331261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53950GMedicaid
CARHM53950GMedicaid