Healthcare Provider Details

I. General information

NPI: 1710931860
Provider Name (Legal Business Name): GRASS VALLEY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SIERRA COLLEGE DRIVE
GRASS VALLEY CA
95945-5089
US

IV. Provider business mailing address

408 SIERRA COLLEGE DRIVE
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 StateCA

VIII. Authorized Official

Name: MARY WHITMORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 530-271-2282