Healthcare Provider Details

I. General information

NPI: 1629249172
Provider Name (Legal Business Name): NORTH STATE SURGERY CENTERS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 COURT ST
REDDING CA
96001-2530
US

IV. Provider business mailing address

2184 COURT ST
REDDING CA
96001-2530
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-4444
  • Fax: 530-246-4445
Mailing address:
  • Phone: 530-246-4444
  • Fax: 530-246-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number230000328
License Number StateCA

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269