Provider Demographics
NPI:1184937468
Name:GRASS VALLEY OUTPATIENT SURGERY CENTER LP
Entity type:Organization
Organization Name:GRASS VALLEY OUTPATIENT SURGERY CENTER LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:480-567-9026
Mailing Address - Street 1:408 SIERRA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5089
Mailing Address - Country:US
Mailing Address - Phone:530-271-2282
Mailing Address - Fax:530-271-2287
Practice Address - Street 1:408 SIERRA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5089
Practice Address - Country:US
Practice Address - Phone:530-271-2282
Practice Address - Fax:530-271-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00935009OtherRAILROAD MEDICARE
CA05C0001757Medicare Oscar/Certification
CAP00935009OtherRAILROAD MEDICARE