Healthcare Provider Details

I. General information

NPI: 1972286037
Provider Name (Legal Business Name): GSU SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

IV. Provider business mailing address

400 PLAZA DR STE 140
FOLSOM CA
95630-4746
US

V. Phone/Fax

Practice location:
  • Phone: 916-235-6802
  • Fax: 916-221-7783
Mailing address:
  • Phone: 916-768-2890
  • Fax: 530-758-3324

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: MR. PAUL SCHRUPP
Title or Position: MANAGER
Credential:
Phone: 916-768-2890