Healthcare Provider Details

I. General information

NPI: 1194536664
Provider Name (Legal Business Name): ALTAMONT SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 9TH ST
TRACY CA
95376-3921
US

IV. Provider business mailing address

ALTAMONT SURGERY CENTER 530 PLAZA DRIVE #110
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 916-235-6802
  • Fax:
Mailing address:
  • Phone: 916-235-6802
  • Fax:

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: PAUL SCHRUPP
Title or Position: MANAGER
Credential:
Phone: 916-768-2890