Provider Demographics
NPI:1578850525
Name:SURGICAL AND TRAUMA SERVICES
Entity Type:Organization
Organization Name:SURGICAL AND TRAUMA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FRACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-984-2455
Mailing Address - Street 1:3234 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6765
Mailing Address - Country:US
Mailing Address - Phone:408-984-2455
Mailing Address - Fax:408-984-2456
Practice Address - Street 1:3234 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6765
Practice Address - Country:US
Practice Address - Phone:408-984-2455
Practice Address - Fax:408-984-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty