MEDICARE: ST. JOSEPH'S SURGERY CENTER LP

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	EXEMPT FROM LICENSUR	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00215810	OTHER	CA	MEDICARE RAILROAD CARRIER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CA0300001807	OTHER	CA	MISC

General Provider Information

NPI Number	:	1619974219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH'S SURGERY CENTER LP

Provider Business Mailing Address
First Line	:	1800 N CALIFORNIA ST
Second Line	:	STE 1
City	:	STOCKTON
State	:	CA
Zip	:	95204-6019
Country	:	US
Telephone Number	:	209-467-6316
Fax Number	:	209-461-6895

Provider Business Practice Location Address
First Line	:	1800 N CALIFORNIA ST
Second Line	:	STE 1
City	:	STOCKTON
State	:	CA
Zip	:	95204-6019
Country	:	US
Telephone Number	:	209-467-6316
Fax Number	:	209-461-6895

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ERIC BOON
Credential	:
Telephone Number	:	480-567-0269

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/23/2024

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Directions to “ST. JOSEPH'S SURGERY CENTER LP ” Practice Location

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