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Organization
DIGNITY HEALTH MEDICAL FOUNDATION
Active
Organization
DIGNITY HEALTH MEDICAL FOUNDATION
Active
Parent organization
DIGNITY HEALTH MEDICAL FOUNDATION
Other names
Mercy Medical Group, a service of Dignity Health Medical Foundation
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIGNITY HEALTH MEDICAL FOUNDATION
Authorized official
THERESA M HYLEN (CHIEF FINANCIAL OFFICER)
(916) 851-2559
Entity
Organization
Contact information
Practice address
1792 TRIBUTE RD, SUITE 350, SACRAMENTO, CA 95815-4305
(916) 924-6400
(916) 648-9869
Mailing address
PO BOX 60000, FILE #72938, SAN FRANCISCO, CA 94160-2938
(916) 733-3397
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019838
CIGNA
—
01
—
195
HEALTH NET
—
01
—
341996544
SPECIAL PURPOSE TAX ID #
—
01
—
476040021
DME SUPPLIER #
—
01
—
983
HEALTH NET
—
05
—
GR006356C
—
CA
01
—
ZZZ29342Z
BSCA PRO FEES
—
01
—
ZZZ60278Z
BLUE SHIELD
—
Enumeration date
03/15/2007
Last updated
11/18/2020
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