Provider Demographics
NPI:1194536664
Name:ALTAMONT SURGERY CENTER
Entity type:Organization
Organization Name:ALTAMONT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-768-2890
Mailing Address - Street 1:ALTAMONT SURGERY CENTER
Mailing Address - Street 2:530 PLAZA DRIVE #110
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-235-6802
Mailing Address - Fax:
Practice Address - Street 1:205 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3921
Practice Address - Country:US
Practice Address - Phone:916-235-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical