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General NPI Number Information
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NPI Number | 1720044605
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Entity Type | Organization
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Legal Business Name | TRACY OUTPATIENT SURGERY CENTER
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 530 W EATON AVE STE P
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City | TRACY
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State | CA
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Zip | 95376
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Country | US
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Telephone | 209-833-8797
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Fax | 209-835-3246
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Provider Business Mailing Address
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Address Line | 530 W EATON AVE STE P
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City | TRACY
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State | CA
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Zip | 95376
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Country | US
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Telephone | 209-833-8797
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Fax | 209-835-3246
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HARPREET S GREWAL
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Credential | M.D.
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Telephone | 209-833-8797
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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 | CA030001797
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | CA030001797
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License Number State | CA
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