Healthcare Provider Details

I. General information

NPI: 1487136412
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 TIMBERLAKE WAY STE 103
SACRAMENTO CA
95823-5413
US

IV. Provider business mailing address

15305 DALLAS PKWY STE 1600
ADDISON TX
75001-6491
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-2350
  • Fax: 916-681-2370
Mailing address:
  • Phone: 972-763-3893
  • Fax: 972-692-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC BOON
Title or Position: AUTHORIZED OFFICIAL / OFFICER
Credential:
Phone: 480-567-0259