Provider Demographics
NPI:1467451096
Name:SOUTH PLACER SURGERY CENTER L P
Entity type:Organization
Organization Name:SOUTH PLACER SURGERY CENTER L P
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-566-4907
Mailing Address - Street 1:8 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2185
Mailing Address - Country:US
Mailing Address - Phone:916-577-5070
Mailing Address - Fax:916-577-5071
Practice Address - Street 1:8 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2185
Practice Address - Country:US
Practice Address - Phone:916-677-5070
Practice Address - Fax:916-677-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03000772261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
220182400OtherUS DEPT OF LABOR
CASUR01608FMedicaid
CAZZZH3100ZOtherBLUE SHIELD
AS1608OtherBLUE CROSS
ZZZ25450ZMedicare ID - Type Unspecified