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4th Street Laser & Surgery Center Inc

Ambulatory Surgical Clinic/Center in Santa Rosa, CA · enumerated 2006 · authorized official Elayne Clark, Administrator.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1902964174

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Registry record

Entity type Organization (Type 2)
Legal business name 4th Street Laser & Surgery Center Inc
Practice address 1720 4th St, Santa Rosa, CA, 95404
Phone (707) 546-8100
Fax (707) 544-6438
Enumeration date Dec 4, 2006
Last updated in NPPES Jan 17, 2013

Taxonomy & classification

261QA1903X Ambulatory Surgical Clinic/Center Ambulatory Health Care Facilities · License 110000344 (CA) Primary

Authorized official

Name Elayne Clark
Title Administrator
Phone (707) 546-8100

Other identifiers

Identifier Type State Issuer
SUR01428G Medicaid CA -
110000344 Other CA STATE OF CA LICENSE

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for 4th Street Laser & Surgery Center Inc?
The NPI for 4th Street Laser & Surgery Center Inc is 1902964174, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for 4th Street Laser & Surgery Center Inc?
NPPES lists Elayne Clark (Administrator) as the authorized official for this organization.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2013-01-17.