MEDICARE: SAN FRANCISCO SURGICENTER, MEDICAL CLINIC, A CALIFORNIA LIMITED PARTNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1376505685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN FRANCISCO SURGICENTER, MEDICAL CLINIC, A CALIFORNIA LIMITED PARTNE

Provider Business Mailing Address
First Line	:	1635 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3043
Country	:	US
Telephone Number	:	415-386-1218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3036
Country	:	US
Telephone Number	:	415-386-1218
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY WOOD
Credential	:
Telephone Number	:	828-236-3027

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	04/08/2009

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