Healthcare Provider Details

I. General information

NPI: 1245285857
Provider Name (Legal Business Name): AMBULATORY SURGERY CENTER OF EAGER STEVEN E MD GEN PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 N CALIFORNIA ST
STOCKTON CA
95204-5506
US

IV. Provider business mailing address

2388 N CALIFORNIA ST
STOCKTON CA
95204-5506
US

V. Phone/Fax

Practice location:
  • Phone: 209-944-9100
  • Fax: 209-944-4509
Mailing address:
  • Phone: 209-944-9100
  • Fax: 209-944-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number030000758
License Number StateCA

VIII. Authorized Official

Name: MS. NICKI CRAIG
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-944-9100