Healthcare Provider Details

I. General information

NPI: 1568428456
Provider Name (Legal Business Name): UKIAH SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 OBSERVATORY AVE
UKIAH CA
95482-5757
US

IV. Provider business mailing address

271 OBSERVATORY AVE
UKIAH CA
95482-5757
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-2120
  • Fax:
Mailing address:
  • Phone: 707-467-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0110000321
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY WOOD
Title or Position: DIRECTOR
Credential:
Phone: 828-236-3027