MEDICARE: SURGICAL AFFILIATES MANAGEMENT GROUP, INC.

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	2086S0102X	Surgical Critical Care Physician	314780	CA
2	2086S0127X	Trauma Surgery Physician	314780	CA
3	208600000X	Surgery Physician	314780	CA

General Provider Information

NPI Number	:	1780877217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL AFFILIATES MANAGEMENT GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1528
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95812-1528
Country	:	US
Telephone Number	:	916-441-0400
Fax Number	:	916-441-0406

Provider Business Practice Location Address
First Line	:	555 CAPITOL MALL STE 260
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-4503
Country	:	US
Telephone Number	:	916-441-0400
Fax Number	:	916-441-0406

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEON JOSEPH OWENS
Credential	:	M.D.
Telephone Number	:	916-441-0400

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/29/2013

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