MEDICARE: PRESIDIO SURGERY CENTER, LLC

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	TBD	CA

General Provider Information

NPI Number	:	1609826361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESIDIO SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1635 DIVISADERO ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 DIVISADERO ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3036
Country	:	US
Telephone Number	:	415-346-1218
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. JESSIE SCOTT
Credential	:	P.T., M.B.A.
Telephone Number	:	415-600-1484

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/22/2020

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