Provider Demographics
NPI:1821092206
Name:SUTTER FAIRFIELD SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SUTTER FAIRFIELD SURGERY CENTER, LLC
Other - Org Name:SUTTER FAIRFIELD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR SFSC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-432-2710
Mailing Address - Street 1:2700 LOW CT
Mailing Address - Street 2:FL 2
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9715
Mailing Address - Country:US
Mailing Address - Phone:707-432-2700
Mailing Address - Fax:707-432-2701
Practice Address - Street 1:2700 LOW CT
Practice Address - Street 2:FL 2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9715
Practice Address - Country:US
Practice Address - Phone:707-432-2700
Practice Address - Fax:707-432-2701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTERMEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000525261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01696FMedicaid
CA7768573Medicare UPIN
CASUR01696FMedicaid