Healthcare Provider Details

I. General information

NPI: 1205894466
Provider Name (Legal Business Name): DAVIS SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 COWELL BLVD SUITE 142
DAVIS CA
95618-7840
US

IV. Provider business mailing address

20 BURTON HILLS BLVD. SUITE 500 ATTN: L&C
NASHVILLE TN
37215-6176
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-7766
  • Fax: 530-750-7767
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number030001792
License Number StateCA

VIII. Authorized Official

Name: MR. PHILLIP A CLENDENIN
Title or Position: PRESIDENT OF LP
Credential:
Phone: 615-665-1283