# SONORA COMMUNITY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SONORA COMMUNITY HOSPITAL
- **Other names:** Forest Road Health & Wellness Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003014952
- **Legal business name:** SONORA COMMUNITY HOSPITAL
- **Authorized official:** GREGORY D MCCULLOCH (CEO)
- **Authorized official phone:** (209) 536-5011

## Contact information

- **Practice address:** 193 FAIRVIEW LN, SONORA, CA 95370-4828
- **Practice address phone:** (209) 536-5100
- **Practice address fax:** (209) 536-5108
- **Mailing address:** PO BOX 398852, SAN FRANCISCO, CA 94139-8852
- **Mailing address phone:** (209) 536-3900
- **Mailing address fax:** (209) 533-7696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/03/2007
- **Last updated:** 08/22/2019