Provider Demographics
NPI:1952692659
Name:NORTH BAY REGIONAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTH BAY REGIONAL SURGERY CENTER, LLC
Other - Org Name:NOVATO ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, SSCD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-286-8202
Mailing Address - Street 1:100 ROWLAND WAY
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5011
Mailing Address - Country:US
Mailing Address - Phone:415-209-2520
Mailing Address - Fax:
Practice Address - Street 1:7595 REDWOOD BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-7700
Practice Address - Country:US
Practice Address - Phone:415-892-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical