1588831531 NPI number — SURGICAL ANESTHESIA SERVICES OF CALIFORNIA

Table of content: (NPI 1588831531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588831531 NPI number — SURGICAL ANESTHESIA SERVICES OF CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ANESTHESIA SERVICES OF CALIFORNIA
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:
Provider Other Organization Name Type Code:
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:
1588831531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13523 BARRETT PARKWAY DRIVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63021-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-549-2404
Provider Business Mailing Address Fax Number:
636-549-2392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 COWELL BLVD.
Provider Second Line Business Practice Location Address:
SUITE 142
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95618-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-750-7755
Provider Business Practice Location Address Fax Number:
530-750-7767
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIBAUDO
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-217-2659

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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