Provider Demographics
NPI:1508861881
Name:EL DORADO SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:EL DORADO SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-344-1687
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:STE E
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-344-1687
Mailing Address - Fax:530-344-1561
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:STE E
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-1687
Practice Address - Fax:530-344-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000767261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA354098600OtherDEPT OF LABOR #
CASUR01560FMedicaid
CAAS1560OtherBLUE CROSS #
CA490005585OtherRAILROAD #
CACGP171564OtherCCS #
CAZZZH09022OtherBLUE SHIELD #
CAZZZH09022OtherBLUE SHIELD #
CA490005585OtherRAILROAD #