Provider Demographics
NPI:1235106782
Name:VALLEY SURGERY CENTER AT MODESTO, LLC
Entity Type:Organization
Organization Name:VALLEY SURGERY CENTER AT MODESTO, LLC
Other - Org Name:VALLEY SURGERY CENTER, LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-571-1633
Mailing Address - Street 1:1300 MABLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1120
Mailing Address - Country:US
Mailing Address - Phone:209-571-1633
Mailing Address - Fax:209-491-0772
Practice Address - Street 1:1300 MABLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1120
Practice Address - Country:US
Practice Address - Phone:209-571-1633
Practice Address - Fax:206-491-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical