Provider Demographics
NPI:1467451096
Name:SOUTH PLACER SURGERY CENTER LP
Entity Type:Organization
Organization Name:SOUTH PLACER SURGERY CENTER LP
Other - Org Name:SUTTER SIERRA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, SSCD
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 1:8 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2185
Mailing Address - Country:US
Mailing Address - Phone:916-577-5070
Mailing Address - Fax:916-577-5071
Practice Address - Street 1:8 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2185
Practice Address - Country:US
Practice Address - Phone:916-677-5070
Practice Address - Fax:916-677-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03000772261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH3100ZOtherBLUE SHIELD
CASUR01608FMedicaid
AS1608OtherBLUE CROSS
220182400OtherUS DEPT OF LABOR
ZZZ25450ZMedicare ID - Type Unspecified