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General NPI Number Information
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NPI Number | 1386966935
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Entity Type | Organization
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Legal Business Name | NORCAL SPECIALTY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 730 BENNETT VALLEY RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-5514
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Country | US
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Telephone | 707-396-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 730 BENNETT VALLEY RD
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City | SANTA ROSA
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State | CA
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Zip | 95404-5514
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Country | US
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Telephone | 707-396-5200
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Fax | 707-396-5257
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC STEPHAN SCHMIDT
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Credential | M.D.
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Telephone | 707-396-5200
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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 | 20098510003
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License Number State | CA
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