Provider Demographics
NPI:1528012978
Name:NORTHERN CALIFORNIA SURGERY CENTER LP
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ DON
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-668-9866
Mailing Address - Street 1:3850 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1146
Mailing Address - Country:US
Mailing Address - Phone:209-668-9866
Mailing Address - Fax:209-668-9843
Practice Address - Street 1:3850 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1146
Practice Address - Country:US
Practice Address - Phone:209-668-9866
Practice Address - Fax:209-668-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000135261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS1758OtherBLUE CROSS
CA05C0001758OtherCCN
CAAS1758OtherBLUE CROSS
CASUR01758FOtherMEDI-CAL
P00331580OtherRAILROAD MEDICARE