1114921541 NPI number — SACRAMENTO SURGERY CENTER ASSOC., LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114921541 NPI number — SACRAMENTO SURGERY CENTER ASSOC., LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRAMENTO SURGERY CENTER ASSOC., LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAPITOL CITY SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114921541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 TRIBUTE RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95815-4314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-925-2700
Provider Business Mailing Address Fax Number:
916-925-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 TRIBUTE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95815-4314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-925-2700
Provider Business Practice Location Address Fax Number:
916-925-2210
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHARFF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT/SECRETARY
Authorized Official Telephone Number:
205-545-2572

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  030000780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SUR01635F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6801635F . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS1635 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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