1033426580 NPI number — ADVANCED AMBULATORY SURGERY CENTER, LLC

Table of content: (NPI 1033426580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033426580 NPI number — ADVANCED AMBULATORY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED 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:
1033426580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 PROFESSIONAL BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47714-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-758-4071
Provider Business Mailing Address Fax Number:
812-205-2654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PROFESSIONAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-8016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-758-4071
Provider Business Practice Location Address Fax Number:
812-205-2654
Provider Enumeration Date:
09/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
STRAW
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
812-758-4034

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 1055762A , 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: 7100212490 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201070290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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