Provider Demographics
NPI:1487854600
Name:SACRAMENTO PLASTIC & RECONSTRUCTIVE SURGERY MEDICAL GROUP INC
Entity type:Organization
Organization Name:SACRAMENTO PLASTIC & RECONSTRUCTIVE SURGERY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHRIOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-929-1833
Mailing Address - Street 1:95 SCRIPPS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6320
Mailing Address - Country:US
Mailing Address - Phone:916-929-1833
Mailing Address - Fax:916-929-6730
Practice Address - Street 1:95 SCRIPPS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6320
Practice Address - Country:US
Practice Address - Phone:916-929-1833
Practice Address - Fax:916-929-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25075Medicare UPIN
CA00G401610Medicare PIN
CA00G480210Medicare PIN
CA00A654410Medicare PIN
CAA24279Medicare UPIN
CA00A235650Medicare PIN
CAA48116Medicare UPIN
CAH44319Medicare UPIN
CA00A250880Medicare PIN
CA00A822090Medicare PIN
CAA23596Medicare UPIN
CAI55829Medicare UPIN