4Th Street Laser & Surgery Center Inc

LBN: 4Th Street Laser & Surgery Center Inc
4Th Street Laser & Surgery Center Inc is an health care organization with primary practice located at 1720 4Th St , Santa Rosa CA 95404-3602. The organization recently has only one registered license in Ambulatory Health Care Facilities / Ambulatory Surgical, which is considered as the primary health care specialty. 4Th Street Laser & Surgery Center Inc can be contacted via phone (707) 546-8100, or through Clark, Elayne via phone (707) 546-8100.

Contact Information

Primary practice address
1720 4Th St Santa Rosa CA 95404-3602
Phone: (707) 546-8100
Fax: (707) 544-6438
Website:
Map and Directions
Authorized official contact:
Name: Clark, Elayne RN CASC
Phone: (707) 546-8100

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Ambulatory Surgical 261QA1903X 110000344 California

Profile Details

NPI number 1902964174
LBN Legal business name 4Th Street Laser & Surgery Center Inc
DBA Doing business as
Authorized official Clark, Elayne RN CASC
Entity Organization
Organization subpart 1 No
Enumeration date Dec 4th, 2006
Last updated Jan 17th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902964174 NPPES
California MEDICAID SUR01428G
California Other 110000344

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