1831125962 NPI number — APAC SURGICAL CENTER II, LLC

Table of content: (NPI 1831125962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831125962 NPI number — APAC SURGICAL CENTER II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APAC SURGICAL CENTER II, 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:
APAC SURGERY CENTER II LLC
Provider Other Organization Name Type Code:
3
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:
1831125962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 JOLIET ST.
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DYER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46311-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-227-3622
Provider Business Mailing Address Fax Number:
219-865-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11460 S. BROADWAY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-488-0155
Provider Business Practice Location Address Fax Number:
219-865-5401
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAHMAN
Authorized Official First Name:
FAISAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
219-865-3819

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  06-002683-3 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 11-002683-1 , 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: 000000194412 . This is a "BCBS OF INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200321120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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