1689393746 NPI number — ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, 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 1689393746 NPI number — ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, 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:
1689393746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1619 SKYLINE CIRCLE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88220-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-202-0630
Provider Business Mailing Address Fax Number:
888-572-7765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 SKYLINE CIRCLE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-202-0630
Provider Business Practice Location Address Fax Number:
888-572-7765
Provider Enumeration Date:
08/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WACKER
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
575-302-1666

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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