Healthcare Provider Details

I. General information

NPI: 1700057254
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

2175 ROSALINE AVE STE A
REDDING CA
96001-2549
US

IV. Provider business mailing address

2175 ROSALINE AVE STE A
REDDING CA
96001-2549
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-7400
  • Fax: 530-225-7405
Mailing address:
  • Phone: 530-225-7400
  • Fax: 530-225-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number230000354
License Number StateCA

VIII. Authorized Official

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