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
1700 PRAIRIE CITY RD, FOLSOM, CA 95630-9594
(916) 351-4800
(916) 351-4899
Mailing address
PO BOX 60000, FILE #72938, SAN FRANCISCO, CA 94160-2938
(916) 733-3397
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019838
CIGNA
—
01
—
195
HEALTH NET
—
01
—
1BY
BLUE CROSS
—
01
—
341996544
SPECIAL PURPOSE TAX ID #
—
01
—
983
HEALTH NET
—
05
—
GR0091673
—
CA
01
—
ZZZ13173Z
BLUE SHIELD OF CA
—
Enumeration date
03/16/2007
Last updated
11/18/2020
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