Provider Demographics
NPI:1245327493
Name:THE SURGERY CENTER OF ALTA BATES SUMMIT MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:THE SURGERY CENTER OF ALTA BATES SUMMIT MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-547-2244
Mailing Address - Street 1:3875 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2428
Mailing Address - Country:US
Mailing Address - Phone:510-547-2244
Mailing Address - Fax:
Practice Address - Street 1:3875 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2428
Practice Address - Country:US
Practice Address - Phone:510-547-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
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
CAZZZH0117ZOtherBLUE SHIELD
CA551028OtherBLUE CROSS
CAZZZ31748ZMedicare ID - Type Unspecified