Provider Demographics
NPI:1396033882
Name:NORTHERN CALIFORNIA SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA SURGICAL ASSOCIATES, INC.
Other - Org Name:BENJAMIN D. SHADLE, MD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHADLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-688-7000
Mailing Address - Street 1:8120 TIMBERLAKE WAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5412
Mailing Address - Country:US
Mailing Address - Phone:916-688-7000
Mailing Address - Fax:916-688-7005
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 109
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-688-7000
Practice Address - Fax:916-688-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99595208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty