Healthcare Provider Details

I. General information

NPI: 1700069549
Provider Name (Legal Business Name): ACUTE CARE SURGERY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2007
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K STREET SUITE 440
SACRAMENTO CA
95816-5616
US

IV. Provider business mailing address

PO BOX 888102
SAN FRANCISCO CA
94139-8102
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0400
  • Fax: 916-441-0406
Mailing address:
  • Phone: 916-441-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number3056079
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number3056079
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3056079
License Number StateCA

VIII. Authorized Official

Name: MR. SCOTT FLACKS
Title or Position: COO
Credential:
Phone: 916-441-0400