Basic Information
| Provider Information | |||||||||
| NPI: | 1992752794 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIERRA AMBULATORY SURGERY CENTER, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932914331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597347272 | ||||||||
| FaxNumber: | 5597337438 | ||||||||
| Practice Location | |||||||||
| Address1: | 2828 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932914331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597347272 | ||||||||
| FaxNumber: | 5597337438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 06/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARQUEZ | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR BUSINESS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 5597347272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 05-C0001473 | 01 | CA | DEPT HEALTH & HUMAN SERVI | OTHER | SUR01473F | 05 | CA | MEDICAID |