Healthcare Provider Details

I. General information

NPI: 1821092206
Provider Name (Legal Business Name): SUTTER FAIRFIELD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LOW CT FL 2
FAIRFIELD CA
94534-9715
US

IV. Provider business mailing address

2700 LOW CT FL 2
FAIRFIELD CA
94534-9715
US

V. Phone/Fax

Practice location:
  • Phone: 707-432-2700
  • Fax: 707-432-2701
Mailing address:
  • Phone: 707-432-2700
  • Fax: 707-432-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number110000525
License Number StateCA

VIII. Authorized Official

Name: MRS. CLARISSA T FEGAN
Title or Position: ADMINISTRATOR SFSC
Credential:
Phone: 707-432-2710