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Organization
CAPITOL CITY MEDICAL GROUP, INC
Active
Organization
CAPITOL CITY MEDICAL GROUP, INC
Active
Other names
Capital City Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MARY ULLERY (ADMINISTRATOR)
(916) 920-1200
Entity
Organization
Contact information
Practice address
500 UNIVERSITY AVE, SUITE 200, SACRAMENTO, CA 95825-6523
(916) 920-1200
Mailing address
500 UNIVERSITY AVE, SUITE 200, SACRAMENTO, CA 95825-6523
(916) 920-1200
Taxonomy
Speciality
Code
Description
License number
State
2471B0102X
Bone Densitometry Radiologic Technologist
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0088950
—
CA
01
—
ZZZ61216Z
BLUE SHIELD PROVIDER ID
CA
Enumeration date
01/04/2006
Last updated
09/11/2025
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