DIGNITY HEALTH MEDICAL FOUNDATION NPI 1699971333

NPI Information

NPI: 1699971333
Provider Name: DIGNITY HEALTH MEDICAL FOUNDATION

Doing Business As: DIGNITY HEALTH MEDICAL GROUP - DOMINICAN, A SERVICE OF DIGNITY HEALTH

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
13350 BIG BASIN WAY
BOULDER CREEK, CA
ZIP 95006
Phone: (831) 338-2767
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DIGNITY HEALTH MEDICAL FOUNDATION is a multi-specialty clinic center in Boulder Creek, CA. DIGNITY HEALTH MEDICAL FOUNDATION NPI is 1699971333. The provider is registered as an organization entity type.
The provider Is Doing Business As Dignity Health Medical Group - Dominican, A Service Of Dignity Health.

The provider's business location address is:

13350 BIG BASIN WAY
BOULDER CREEK, CA
ZIP 95006-237
Phone: (831) 338-2767
Fax: (831) 338-2767

The provider's authorized official is Theresa M Hylen .
The authorized official title is Chief Financial Officer and has the following contact phone number (916) 851-2559.

The CLIA number assigned to this NPI record is 05D0605277 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/21/2007 and was last updated on 11/18/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0091683	MEDICAID	CALIFORNIA
2	ZZZ50290Z	OTHER		BSCA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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