Basic Information
| Provider Information | |||||||||
| NPI: | 1033453311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER AMADOR SURGERY CENTER LLC | ||||||||
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| OtherOrganizationName: | SUTTER AMADOR SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 CLINTON RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | JACKSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956422680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092235938 | ||||||||
| FaxNumber: | 2092571599 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 CLINTON RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | JACKSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956422680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092235938 | ||||||||
| FaxNumber: | 2092571599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | BOARD CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 9162868202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.