Provider Demographics
NPI:1538280284
Name:PHYSICIANS SURGERY CENTER OF MODESTO INC
Entity Type:Organization
Organization Name:PHYSICIANS SURGERY CENTER OF MODESTO INC
Other - Org Name:RIVER SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:209-527-6700
Mailing Address - Street 1:609 E ORANGEBURG AVE # B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5580
Mailing Address - Country:US
Mailing Address - Phone:209-527-6700
Mailing Address - Fax:
Practice Address - Street 1:609 E ORANGEBURG AVE # B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5580
Practice Address - Country:US
Practice Address - Phone:209-527-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0557938261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFEDERAL TAX ID
CAA-27474Medicare UPIN