Healthcare Provider Details

I. General information

NPI: 1184937468
Provider Name (Legal Business Name): GRASS VALLEY OUTPATIENT SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5089
US

IV. Provider business mailing address

408 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5089
US

V. Phone/Fax

Practice location:
  • Phone: 530-271-2282
  • Fax: 530-271-2287
Mailing address:
  • Phone: 530-271-2282
  • Fax: 530-271-2287

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: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-9026