Provider Demographics
NPI:1174597819
Name:PROCEDURE CENTER OF SOUTH SACRAMENTO INC
Entity type:Organization
Organization Name:PROCEDURE CENTER OF SOUTH SACRAMENTO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:IMPERATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-423-2124
Mailing Address - Street 1:8120 TIMBERLAKE WAY
Mailing Address - Street 2:STE 103
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5412
Mailing Address - Country:US
Mailing Address - Phone:916-423-2124
Mailing Address - Fax:916-423-2127
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:STE 103
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-423-2124
Practice Address - Fax:916-423-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000773261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00106216OtherRAILROAD MEDICARE
CASUR01604FMedicaid
CASUR01604FMedicaid