Provider Demographics
NPI:1881806453
Name:REDWOOD EMPIRE SURGERY CENTER, INC
Entity type:Organization
Organization Name:REDWOOD EMPIRE SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BELLE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-838-6560
Mailing Address - Street 1:1380 19TH HOLE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7713
Mailing Address - Country:US
Mailing Address - Phone:707-838-6560
Mailing Address - Fax:707-838-8464
Practice Address - Street 1:1380 19TH HOLE DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7713
Practice Address - Country:US
Practice Address - Phone:707-838-6560
Practice Address - Fax:707-838-8464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
05C0001852Medicare Oscar/Certification