Provider Demographics
NPI:1922625995
Name:NATIONAL SURGICAL CENTERS STOCKTON, LLC
Entity type:Organization
Organization Name:NATIONAL SURGICAL CENTERS STOCKTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-919-9560
Mailing Address - Street 1:561 WINDING BROOK FARM RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1747
Mailing Address - Country:US
Mailing Address - Phone:310-919-9560
Mailing Address - Fax:
Practice Address - Street 1:415 E HARDING WAY STE E
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:310-919-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical