Provider Demographics
NPI:1356490916
Name:JESSE M. KRAMER, M.D.
Entity Type:Organization
Organization Name:JESSE M. KRAMER, M.D.
Other - Org Name:ASSOCIATES OUTPATIENT SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-246-9736
Mailing Address - Street 1:2128 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0427
Mailing Address - Country:US
Mailing Address - Phone:530-246-9736
Mailing Address - Fax:530-246-4052
Practice Address - Street 1:2128 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0427
Practice Address - Country:US
Practice Address - Phone:530-246-9736
Practice Address - Fax:530-246-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX16303Medicare UPIN
CAZZZ13257ZMedicare PIN