1982672283 NPI number — ROSEVILLE SURGERY CENTER, LP

Table of content: AMY RUTH HUFFSTUTLAR PTA (NPI 1487872503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982672283 NPI number — ROSEVILLE SURGERY CENTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEVILLE SURGERY CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1982672283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 DALLAS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-677-2488
Provider Business Mailing Address Fax Number:
916-677-2496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 E ROSEVILLE PKWY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-677-2488
Provider Business Practice Location Address Fax Number:
916-677-2496
Provider Enumeration Date:
03/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOON
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
480-567-0269

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  030000764 , 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: P00366559 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MEDI-CAL 05C0001572 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".