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Organization
SUTTER LAKESIDE HOSPITAL
Active
Organization
SUTTER LAKESIDE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY MATHER CEO (CEO)
(707) 262-5001
Entity
Organization
Contact information
Practice address
5176 HILL RD E, LAKEPORT, CA 95453-6300
(707) 262-5181
(707) 262-5006
Mailing address
5176 HILL RD E, LAKEPORT, CA 95453-6300
(707) 262-5181
(707) 262-5006
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
010000118
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050476
MEDICARE PROVIDER NUMBER
CA
01
—
050476
BLUE CROSS
—
01
—
C083612
CHAMPVA
—
01
—
CGP127375
CHILDREN SERVICES
CA
01
—
HSP13994F
HAP
—
05
—
HSP40476F
—
CA
05
—
ZZR00476F
—
CA
01
—
ZZZC1701Z
BLUE SHIELD
—
Enumeration date
09/14/2005
Last updated
07/31/2008
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