Basic Information
| Provider Information | |||||||||
| NPI: | 1235187972 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NOBLE SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5021 W NOBLE AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932778310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596252020 | ||||||||
| FaxNumber: | 5596252121 | ||||||||
| Practice Location | |||||||||
| Address1: | 5021 W NOBLE AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932778310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596252020 | ||||||||
| FaxNumber: | 5596252121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | GEIGER | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | JONES | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5596252020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 120000663 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | SUR01606F | 05 | CA | MEDICAID |