Provider Demographics
NPI:1912094509
Name:APOGEE OUTPATIENT SURGERY CENTER
Entity Type:Organization
Organization Name:APOGEE OUTPATIENT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-246-2467
Mailing Address - Street 1:1238 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-241-5499
Mailing Address - Fax:530-242-9460
Practice Address - Street 1:1238 WEST STREET
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-241-5499
Practice Address - Fax:530-242-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5500000028948476OtherNATIONAL PRACTITIONER
CA230000324OtherCALIFORNIA DHS LICENSE #
CASUR01471FMedicaid
CASUR01471FMedicaid