Provider Demographics
NPI:1932102498
Name:MERCY SURGERY CENTER, LP
Entity Type:Organization
Organization Name:MERCY SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-225-7400
Mailing Address - Street 1:2175 ROSALINE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2509
Mailing Address - Country:US
Mailing Address - Phone:530-225-7400
Mailing Address - Fax:530-225-7405
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:STE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2509
Practice Address - Country:US
Practice Address - Phone:530-225-7400
Practice Address - Fax:530-225-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
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
CASUR01643FMedicaid