Provider Demographics
NPI:1861867855
Name:SIERRA PACIFIC SURGICAL, INC.
Entity type:Organization
Organization Name:SIERRA PACIFIC SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SKEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-250-2596
Mailing Address - Street 1:2001 RATTLESNAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9722
Mailing Address - Country:US
Mailing Address - Phone:916-663-2100
Mailing Address - Fax:916-663-2103
Practice Address - Street 1:584 N SUNRISE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2862
Practice Address - Country:US
Practice Address - Phone:916-250-2596
Practice Address - Fax:916-550-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10739208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty