Healthcare Provider Details

I. General information

NPI: 1073773602
Provider Name (Legal Business Name): HUMBOLDT BAY SURGERY CO-OPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 23RD ST
EUREKA CA
95501-3231
US

IV. Provider business mailing address

2324 23RD ST
EUREKA CA
95501-3231
US

V. Phone/Fax

Practice location:
  • Phone: 707-444-1410
  • Fax:
Mailing address:
  • Phone: 707-444-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CAROLYN M JANSSEN
Title or Position: DIRECTOR
Credential: RN
Phone: 707-444-1410