NPIMap

Organization Active NPI

PSC Stockton Outpatient Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
National Provider Identifier
1417405234
Registry record updated Sep 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
A110013 Issued in CA
Legal business name
PSC STOCKTON OUTPATIENT SURGERY CENTER, LLC
Practice address
1805 N California St
Suite 405
Stockton, CA 95204-6037
Phone
(209) 870-7100
Fax
(209) 870-7116
NPI assigned
Sep 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nathan Andrew Kludt, MD
Title
President
Phone
(209) 870-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X A110013 CA Primary

Addresses

Primary practice location

1805 N California St
Suite 405
Stockton, CA 95204-6037

Mailing address

1805 N California St
Suite 405
Stockton, CA 95204-6037
Phone (209) 870-7100

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1417405234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST",
            "address_2": "SUITE 405",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046037",
            "telephone_number": "209-870-7100",
            "fax_number": "209-870-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST",
            "address_2": "SUITE 405",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046037",
            "telephone_number": "209-870-7100",
            "fax_number": "209-870-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSC STOCKTON OUTPATIENT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "KLUDT",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-870-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "A110013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.