Provider Demographics
NPI:1780683078
Name:COURT STREET SURGERY CENTER, LP
Entity Type:Organization
Organization Name:COURT STREET SURGERY CENTER, LP
Other - Org Name:REDDING SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:KUROSAKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-246-4444
Mailing Address - Street 1:2439 SONOMA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3026
Mailing Address - Country:US
Mailing Address - Phone:530-241-1303
Mailing Address - Fax:530-241-0200
Practice Address - Street 1:2439 SONOMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3026
Practice Address - Country:US
Practice Address - Phone:530-241-1303
Practice Address - Fax:530-241-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-12-14
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
CAAS1517OtherBLUE CROSS
CAZZZH4507ZOtherBLUE SHIELD
CAP00365910OtherRAILROAD MEDICARE
CASUR01517GMedicaid
CASUR01517GMedicaid