Provider Demographics
NPI:1710931860
Name:GRASS VALLEY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GRASS VALLEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-271-2282
Mailing Address - Street 1:408 SIERRA COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5089
Mailing Address - Country:US
Mailing Address - Phone:530-271-2282
Mailing Address - Fax:530-271-2287
Practice Address - Street 1:408 SIERRA COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5089
Practice Address - Country:US
Practice Address - Phone:530-271-2282
Practice Address - Fax:530-271-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31897ZMedicare PIN