Provider Demographics
NPI:1558339424
Name:PREMIER SURGERY CENTER
Entity Type:Organization
Organization Name:PREMIER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-691-5000
Mailing Address - Street 1:2222 EAST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2084
Mailing Address - Country:US
Mailing Address - Phone:925-691-5000
Mailing Address - Fax:925-691-5023
Practice Address - Street 1:2222 EAST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2084
Practice Address - Country:US
Practice Address - Phone:925-691-5000
Practice Address - Fax:925-691-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000668261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01610FMedicaid
CASUR01610FMedicaid