Provider Demographics
NPI:1114921541
Name:SACRAMENTO SURGERY CENTER ASSOCIATES, L P
Entity Type:Organization
Organization Name:SACRAMENTO SURGERY CENTER ASSOCIATES, L P
Other - Org Name:CAPITOL CITY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, SSCD
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-566-4907
Mailing Address - Street 1:1800 TRIBUTE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-925-2700
Mailing Address - Fax:916-925-2210
Practice Address - Street 1:1800 TRIBUTE RD
Practice Address - Street 2:STE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-925-2700
Practice Address - Fax:916-925-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000780261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01635FMedicaid
6801635FOtherBLUE SHIELD
AS1635OtherBLUE CROSS
ZZZ27193ZMedicare ID - Type Unspecified