Provider Demographics
NPI:1922049881
Name:TRI-VALLEY SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:TRI-VALLEY SURGERY CENTER, L.P.
Other - Org Name:HEALTHSOUTH TRI-VALLEY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5674
Mailing Address - Street 1:4487 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8326
Mailing Address - Country:US
Mailing Address - Phone:925-484-3100
Mailing Address - Fax:
Practice Address - Street 1:4487 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8326
Practice Address - Country:US
Practice Address - Phone:925-484-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
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
CASUR01275FMedicaid
CAMMM00105MMedicare ID - Type Unspecified