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General NPI Number Information
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NPI Number | 1154440972
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Entity Type | Organization
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Legal Business Name | SEBASTOPOL ASC, L.P.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 6880 PALM AVE
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4270
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Country | US
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Telephone | 707-823-7628
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Fax | 707-823-1521
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Provider Business Mailing Address
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Address Line | 6880 PALM AVE
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4270
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Country | US
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Telephone | 707-823-7628
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Fax | 707-823-1521
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | DR. ERIC J KAHLE
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Credential | M.D.
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Telephone | 707-823-7628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 010000189
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License Number State | CA
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