Provider Demographics
NPI:1871759431
Name:SIERRA IMMEDIATE CARE MEDICAL CENTER
Entity type:Organization
Organization Name:SIERRA IMMEDIATE CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SOBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-295-1074
Mailing Address - Street 1:1000 FOWLER WAY
Mailing Address - Street 2:SUITE #7
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5738
Mailing Address - Country:US
Mailing Address - Phone:530-295-1074
Mailing Address - Fax:530-295-0328
Practice Address - Street 1:1000 FOWLER WAY
Practice Address - Street 2:SUITE #7
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-295-1074
Practice Address - Fax:530-295-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 31014261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G392741Medicaid
CAZZZ1691ZMedicare PIN