# SONORA COMMUNITY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SONORA COMMUNITY HOSPITAL
- **Other names:** Foothill Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063403129
- **Legal business name:** SONORA COMMUNITY HOSPITAL
- **Authorized official:** ANDREW D. JAHN (VICE PRESIDENT FOR FINANCE)
- **Authorized official phone:** (209) 536-5011

## Contact information

- **Practice address:** 650 PAULINE CT, SONORA, CA 95370-5210
- **Practice address phone:** (209) 532-5154
- **Practice address fax:** (209) 533-7696
- **Mailing address:** 14542 LOLLY LN, SONORA, CA 95370-9226
- **Mailing address phone:** (209) 536-3900
- **Mailing address fax:** (209) 533-7696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/28/2005
- **Last updated:** 04/02/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ52952Z | BLUE CROSS/BLUE SHIELD | CA |