Healthcare Provider Details

I. General information

NPI: 1174597819
Provider Name (Legal Business Name): PROCEDURE CENTER OF SOUTH SACRAMENTO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 TIMBERLAKE WAY STE 103
SACRAMENTO CA
95823-5412
US

IV. Provider business mailing address

8120 TIMBERLAKE WAY STE 103
SACRAMENTO CA
95823-5412
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-2124
  • Fax: 916-423-2127
Mailing address:
  • Phone: 916-423-2124
  • Fax: 916-423-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number030000773
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS J IMPERATO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 916-423-2124