Provider Demographics
NPI:1477552768
Name:COURT STREET SURGERY CENTER, LP
Entity Type:Organization
Organization Name:COURT STREET SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:KUROSAKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-246-4444
Mailing Address - Street 1:2184 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2530
Mailing Address - Country:US
Mailing Address - Phone:530-246-4444
Mailing Address - Fax:530-246-4445
Practice Address - Street 1:2184 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2530
Practice Address - Country:US
Practice Address - Phone:530-246-4444
Practice Address - Fax:530-246-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-12-14
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
CA051493OtherBLUE CROSS
CAP00081850OtherRAILROAD MEDICARE
CASUR01493GMedicaid
CAZZZH4506ZOtherBLUE SHIELD
CAZZZH4506ZOtherBLUE SHIELD