Basic Information
| Provider Information | |||||||||
| NPI: | 1467999813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEBSTER OUTPATIENT SURGERY CENTER, LLC | ||||||||
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| OtherOrganizationName: | WEBSTER OUTPATIENT SURGERY CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PORTER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256001900 | ||||||||
| FaxNumber: | 9256001908 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PORTER DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256001900 | ||||||||
| FaxNumber: | 9254749794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2017 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | THEODORE | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9256001900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.