Provider Demographics
NPI:1497407894
Name:SANTA ROSA SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:SANTA ROSA SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-495-9632
Mailing Address - Street 1:1739 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3601
Mailing Address - Country:US
Mailing Address - Phone:707-931-5599
Mailing Address - Fax:
Practice Address - Street 1:1739 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3601
Practice Address - Country:US
Practice Address - Phone:707-931-5599
Practice Address - Fax:707-222-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical