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NPI Code Detail

MEDICARE: SANTA ROSA SURGERY CENTER L P

MEDICARE: SANTA ROSA SURGERY CENTER L P
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1457317398
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA ROSA SURGERY CENTER L P
Provider Business Mailing Address
First Line : 34 MARK WEST SPRINGS RD SUITE 100
Second Line : SANTA ROSA SURGERY AND ENDOSCOPY CENTER
City : SANTA ROSA
State : CA
Zip : 95403-1436
Country : US
Telephone Number : 707-541-3500
Fax Number :
Provider Business Practice Location Address
First Line : 34 MARK WEST SPRINGS RD SUITE 100
Second Line : SANTA ROSA SURGERY AND ENDOSCOPY CENTER
City : SANTA ROSA
State : CA
Zip : 95403-1436
Country : US
Telephone Number : 707-541-3500
Fax Number :
Authorized Official
Title or Position : CEO
Name : BRADLEY HEATON
Credential :
Telephone Number : 916-566-4907
Provider Enumeration Date : 04/20/2006
Last Update Date : 05/06/2024

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