Healthcare Provider Details

I. General information

NPI: 1790005304
Provider Name (Legal Business Name): SOAR SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 BAYSHORE HWY
BURLINGAME CA
94010-1215
US

IV. Provider business mailing address

1849 BAYSHORE HWY
BURLINGAME CA
94010-1215
US

V. Phone/Fax

Practice location:
  • Phone: 650-539-6000
  • Fax: 650-539-6001
Mailing address:
  • Phone: 650-539-6000
  • Fax: 650-539-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL F. DILLINGHAM
Title or Position: GENERAL MANAGING PARTNER
Credential: MD
Phone: 650-539-6000