Provider Demographics
NPI:1558417972
Name:SIERRA PLASTIC SURGERY CENTER INC
Entity Type:Organization
Organization Name:SIERRA PLASTIC SURGERY CENTER INC
Other - Org Name:SIERRA SURGERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:EROPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-432-2757
Mailing Address - Street 1:6153 N THESTA
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5266
Mailing Address - Country:US
Mailing Address - Phone:559-432-5757
Mailing Address - Fax:559-432-3556
Practice Address - Street 1:6153 N THESTA
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-432-5757
Practice Address - Fax:559-432-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000310261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051162OtherBLUE CROSS
CA051162OtherBLUE CROSS