Provider Demographics
NPI:1457317398
Name:SANTA ROSA SURGERY CENTER LP
Entity Type:Organization
Organization Name:SANTA ROSA SURGERY CENTER LP
Other - Org Name:SANTA ROSA SURGERY AND ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/AUTH OFF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-566-4770
Mailing Address - Street 1:34 MARK WEST SPRINGS RD SUITE 100
Mailing Address - Street 2:SANTA ROSA SURGERY AND ENDOSCOPY CENTER
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1436
Mailing Address - Country:US
Mailing Address - Phone:707-541-3500
Mailing Address - Fax:
Practice Address - Street 1:34 MARK WEST SPRINGS RD SUITE 100
Practice Address - Street 2:SANTA ROSA SURGERY AND ENDOSCOPY CENTER
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1436
Practice Address - Country:US
Practice Address - Phone:707-541-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051016Medicare PIN