1508861881 NPI number — EL DORADO SURGERY CENTER, INC.

Table of content: (NPI 1508861881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508861881 NPI number — EL DORADO SURGERY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL DORADO SURGERY CENTER, INC.
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:
1508861881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 GOLDEN CENTER DR
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
PLACERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95667-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-344-1687
Provider Business Mailing Address Fax Number:
530-344-1561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 GOLDEN CENTER DR
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-344-1687
Provider Business Practice Location Address Fax Number:
530-344-1561
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKWOOD
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
FACILITY DIRECTOR
Authorized Official Telephone Number:
530-344-1687

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  030000767 , 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: 354098600 . This is a "DEPT OF LABOR #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SUR01560F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AS1560 . This is a "BLUE CROSS #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 490005585 . This is a "RAILROAD #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP171564 . This is a "CCS #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZH09022 . This is a "BLUE SHIELD #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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