Provider Demographics
NPI:1033453311
Name:SUTTER AMADOR SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SUTTER AMADOR SURGERY CENTER LLC
Other - Org Name:SUTTER AMADOR SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-286-8202
Mailing Address - Street 1:223 CLINTON RD
Mailing Address - Street 2:STE 204
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2680
Mailing Address - Country:US
Mailing Address - Phone:209-223-5938
Mailing Address - Fax:209-257-1599
Practice Address - Street 1:223 CLINTON RD
Practice Address - Street 2:STE 204
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2680
Practice Address - Country:US
Practice Address - Phone:209-223-5938
Practice Address - Fax:209-257-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical