Provider Demographics
NPI:1942278692
Name:FOLSOM OUTPATIENT SURGERY CENTER, LP
Entity Type:Organization
Organization Name:FOLSOM OUTPATIENT SURGERY CENTER, LP
Other - Org Name:FOLSOM SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:1651 CREEKSIDE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3833
Mailing Address - Country:US
Mailing Address - Phone:916-673-1990
Mailing Address - Fax:916-673-1999
Practice Address - Street 1:1651 CREEKSIDE DR
Practice Address - Street 2:STE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-673-1990
Practice Address - Fax:916-673-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-03-06
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
CAP00308892OtherRAILROAD MEDICARE
CAZZZ31874ZMedicare PIN
CAP00308892OtherRAILROAD MEDICARE