Provider Demographics
NPI:1811054737
Name:SACRAMENTO MIDTOWN ENDOSCOPY CENTER
Entity type:Organization
Organization Name:SACRAMENTO MIDTOWN ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-454-0655
Mailing Address - Street 1:3941 J ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3624
Mailing Address - Country:US
Mailing Address - Phone:916-733-6940
Mailing Address - Fax:916-733-6934
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:SUITE 460
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3624
Practice Address - Country:US
Practice Address - Phone:916-733-6940
Practice Address - Fax:916-733-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLN218261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551083OtherBLUE CROSS PROV NUMBER
CASUR51083FMedicaid
CASUR51083FMedicaid