Healthcare Provider Details

I. General information

NPI: 1528071891
Provider Name (Legal Business Name): SUTTER STREET ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER STREET SUITE 1212
SAN FRANCISCO CA
94108
US

IV. Provider business mailing address

PO BOX 39000 DEPT 33691-01
SAN FRANCISCO CA
94139
US

V. Phone/Fax

Practice location:
  • Phone: 415-834-1880
  • Fax: 415-834-1180
Mailing address:
  • Phone: 650-493-7729
  • Fax: 650-493-7959

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: RICHARD L SHARFF JR.
Title or Position: VICE PRESIDENT / SECRETARY
Credential:
Phone: 205-545-2572