Organization
ROSEVILLE SURGERY CENTER, LP
Active
Other names
Roseville Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER/AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
1420 E ROSEVILLE PKWY, STE 100, ROSEVILLE, CA 95661-3078
(916) 677-2488
(916) 677-2496
Mailing address
14201 DALLAS PKWY, DALLAS, TX 75254-2916
(916) 677-2488
(916) 677-2496
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
030000764
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MEDI-CAL 05C0001572
—
CA
01
—
P00366559
RAILROAD MEDICARE
CA
Enumeration date
03/10/2006
Last updated
10/11/2024
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