1497782833 NPI number — CARMEL AMBULATORY SURGERY CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497782833 NPI number — CARMEL AMBULATORY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARMEL AMBULATORY SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497782833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13421 OLD MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-1427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-706-1600
Provider Business Mailing Address Fax Number:
317-706-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13421 OLD MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-706-1600
Provider Business Practice Location Address Fax Number:
317-706-1601
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BODEN
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
317-706-1611

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  06-003497-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00086251 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200464700B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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