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Organization
SACRAMENTO UROLOGY MEDICAL CORPORATION
Active
Organization
SACRAMENTO UROLOGY MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA KAY HAINES (OFFICE MANAGER)
(916) 961-2514
Entity
Organization
Contact information
Practice address
6620 COYLE AVE, SUITE 301, CARMICHAEL, CA 95608-6333
(916) 961-2514
(916) 961-0297
Mailing address
6620 COYLE AVE, SUITE 301, CARMICHAEL, CA 95608-6333
(916) 961-2514
(916) 961-0297
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A061116
CA
174400000X
Specialist
Primary
A26739
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114987526
NPI
CA
01
—
1619937463
NPI
CA
01
—
CG8167
RAILROAD MEDICARE GRP ID
CA
01
—
ZZZ03518Z
BLUE SHIELD GROUP ID
CA
Enumeration date
08/20/2006
Last updated
01/08/2008
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