=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558339424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 02/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 EAST ST SUITE 200
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-2084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-691-5000
-----------------------------------------------------
Fax | 925-691-5023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 EAST ST SUITE 200
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-2084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-691-5000
-----------------------------------------------------
Fax | 925-691-5023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KEVIN DEGNAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 925-691-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 140000668
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------