Organization
ST. JOSEPH'S SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
1800 N CALIFORNIA ST, STE 1, STOCKTON, CA 95204-6019
(209) 467-6316
(209) 461-6895
Mailing address
1800 N CALIFORNIA ST, STE 1, STOCKTON, CA 95204-6019
(209) 467-6316
(209) 461-6895
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
EXEMPT FROM LICENSUR
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05-C0001711
—
CA
01
—
CA0300001807
MISC
CA
01
—
P00215810
MEDICARE RAILROAD CARRIER
CA
Enumeration date
06/28/2005
Last updated
10/23/2024
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