Organization
SUTTER CENTRAL VALLEY HOSPITALS
Active
Other names
Memorial Medical Center Opt Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN TRENT HUNTER (VP SHARED SERVICES)
(916) 297-8555
Entity
Organization
Contact information
Practice address
1800 COFFEE ROAD, STE. 110, MODESTO, CA 95355-2803
(209) 569-7642
Mailing address
PO BOX 740152, LOS ANGELES, CA 90074-0152
(855) 398-1633
(209) 569-7362
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
HSP37596
CA
282N00000X
General Acute Care Hospital
Primary
030000061
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
HSP37596
CA
3336C0003X
Community/Retail Pharmacy
HSP37596
CA
3336H0001X
Home Infusion Therapy Pharmacy
HSP37596
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050557
BLUE CROSS
—
01
—
0538009
NABP
CA
05
—
PHB375960
—
CA
Enumeration date
06/12/2006
Last updated
12/02/2013
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