NPIMap

Organization Active NPI

Sutter Lakeside Hospital

  • Rural Health Clinic/Center
  • Lakeport, CA
National Provider Identifier
1053495879
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SUTTER LAKESIDE HOSPITAL
Practice address
5176 Hill Rd E
Lakeport, CA 95453-6300
Phone
(707) 262-5001
Fax
(707) 262-5006
NPI assigned
Oct 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Mather
Title
Ceo
Phone
(707) 262-5001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X CA Primary

Addresses

Primary practice location

5176 Hill Rd E
Lakeport, CA 95453-6300

Mailing address

5176 Hill Rd E
Lakeport, CA 95453-6300
Phone (707) 262-5001

Other names 1

  • Upper Lake Clinic RHC Other name

National Provider Directory

National Provider Directory
Tax ID family
Sutter Lakeside Womens3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053495879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5176 HILL RD E",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536300",
            "telephone_number": "707-262-5001",
            "fax_number": "707-262-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5176 HILL RD E",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536300",
            "telephone_number": "707-262-5001",
            "fax_number": "707-262-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER LAKESIDE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATHER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-262-5001"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upper Lake Clinic RHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakeport, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.