Provider Demographics
NPI:1619525912
Name:SUMMIT SURGERY CENTER MODESTO, INC
Entity Type:Organization
Organization Name:SUMMIT SURGERY CENTER MODESTO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DUBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-918-5181
Mailing Address - Street 1:3621 FOREST GLENN DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1339
Mailing Address - Country:US
Mailing Address - Phone:209-521-9661
Mailing Address - Fax:209-521-2640
Practice Address - Street 1:654 LYELL DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8997
Practice Address - Country:US
Practice Address - Phone:209-521-9661
Practice Address - Fax:209-521-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty