| Mercy San Juan Medical Center | |
|
6501 Coyle Ave Carmichael CA 95608-0306 | |
| (916) 537-5000 | |
| (916) 537-5111 |
| Full Name | Mercy San Juan Medical Center |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 6501 Coyle Ave, Carmichael, California |
| Authorized Official Name and Position | Bob Pascuzzi (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9165375153 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy San Juan Medical Center 3215 Prospect Park Dr Rancho Cordova CA 95670-6017 Ph: (916) 861-1102 | Mercy San Juan Medical Center 6501 Coyle Ave Carmichael CA 95608-0306 Ph: (916) 537-5000 |
| NPI Number | 1972541498 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 06/21/2021 |
| Certification Date | 06/21/2021 |
| Medicare PECOS PAC ID | 2062320559 |
|---|---|
| Medicare Enrollment ID | O20060613000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972541498 | NPI | - | NPPES |
| 196456501 | Other | CA | DEPT. OF LABOR - WC |
| ZZZA3403Z | Other | BLUE SHIELD OF CA | |
| CGP021540 | Medicaid | CA | |
| 942761692956080014 | Other | WPS TRICARE | |
| HSC40516G | Other | CA | CMISP - TRAUMA |
| 942761692 | Other | IRS - PRE-MERGER TAX ID | |
| HSC00516F | Medicaid | CA | |
| HSP40516F | Medicaid | CA | |
| ZZR00516F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | 030000063 (California) | Primary |
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