Provider Demographics
NPI:1730211566
Name:SIERRA FOOTHILL FAMILY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SIERRA FOOTHILL FAMILY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARTHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-295-1523
Mailing Address - Street 1:1000 FOWLER WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5738
Mailing Address - Country:US
Mailing Address - Phone:530-295-1523
Mailing Address - Fax:530-295-0371
Practice Address - Street 1:1000 FOWLER WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-295-1523
Practice Address - Fax:530-295-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB34466Medicare UPIN
CAZZZ15770ZMedicare PIN