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General NPI Number Information
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NPI Number | 1174597819
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Entity Type | Organization
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Legal Business Name | PROCEDURE CENTER OF SOUTH SACRAMENTO INC
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 8120 TIMBERLAKE WAY STE 103
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City | SACRAMENTO
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State | CA
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Zip | 95823-5412
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Country | US
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Telephone | 916-423-2124
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Fax | 916-423-2127
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Provider Business Mailing Address
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Address Line | 8120 TIMBERLAKE WAY STE 103
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City | SACRAMENTO
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State | CA
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Zip | 95823-5412
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Country | US
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Telephone | 916-423-2124
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Fax | 916-423-2127
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. THOMAS J IMPERATO
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Credential | M.D.
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Telephone | 916-423-2124
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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 | 030000773
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License Number State | CA
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