Provider Demographics
NPI:1316192826
Name:EL DORADO SURGERY CENTER LLC
Entity type:Organization
Organization Name:EL DORADO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-344-1687
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-344-1687
Mailing Address - Fax:530-344-1561
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-1687
Practice Address - Fax:530-344-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00783630OtherMEDICARE RAILROAD CARRIER
CA1316192826OtherNPI NUMBER
CASUR01560FMedicaid
CA1316192826OtherNPI NUMBER
05C0001560Medicare Oscar/Certification