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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