MEDICARE: SACRAMENTO SURGERY CENTER ASSOCIATES, L P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	030000780	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6801635F	OTHER	BLUE SHIELD
3	AS1635	OTHER	BLUE CROSS

General Provider Information

NPI Number	:	1114921541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO SURGERY CENTER ASSOCIATES, L P

Provider Business Mailing Address
First Line	:	1800 TRIBUTE RD
Second Line	:	STE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4314
Country	:	US
Telephone Number	:	916-925-2700
Fax Number	:	916-925-2210

Provider Business Practice Location Address
First Line	:	1800 TRIBUTE RD
Second Line	:	STE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4314
Country	:	US
Telephone Number	:	916-925-2700
Fax Number	:	916-925-2210

Authorized Official
Title or Position	:	CEO, SSCD
Name	:	BRADLEY HEATON
Credential	:
Telephone Number	:	916-566-4907

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/17/2024

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