Healthcare Provider Details

I. General information

NPI: 1346287232
Provider Name (Legal Business Name): MODESTO SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E ORANGEBURG AVE SUITE 1
MODESTO CA
95350-5342
US

IV. Provider business mailing address

400 E ORANGEBURG AVE SUITE 1
MODESTO CA
95350-5342
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-3000
  • Fax: 209-526-3133
Mailing address:
  • Phone: 209-526-3000
  • Fax: 209-526-3133

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: MRS. CHRISTY L CASEY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 209-526-3000