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Organization

SEBASTOPOL ASC, L.P.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ERIC J KAHLE M.D. (CORPORATE OFFICER)
(707) 823-7628
Entity
Organization

Contact information

Practice address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521
Mailing address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
010000189
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1154440972
MEDICARE NPI
01
490002015
MEDICARE RET RAILROAD
CA
01
551098
BLUE CROSS
CA
05
SUR51098F
CA
01
ZZZH4909Z
BLUE SHIELD
CA
Enumeration date
03/29/2007
Last updated
01/27/2012
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