Provider Demographics
NPI:1629249172
Name:NORTH STATE SURGERY CENTERS LP
Entity Type:Organization
Organization Name:NORTH STATE SURGERY CENTERS LP
Other - Org Name:COURT STREET SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:2184 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2530
Mailing Address - Country:US
Mailing Address - Phone:530-246-4444
Mailing Address - Fax:530-246-4445
Practice Address - Street 1:2184 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2530
Practice Address - Country:US
Practice Address - Phone:530-246-4444
Practice Address - Fax:530-246-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000328261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01493GMedicaid
CAP00081850OtherRAILROAD MEDICARE
CASUR01493GMedicaid