Provider Demographics
NPI:1033426580
Name:ADVANCED AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-758-4034
Mailing Address - Street 1:1101 PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8016
Mailing Address - Country:US
Mailing Address - Phone:812-758-4071
Mailing Address - Fax:812-205-2654
Practice Address - Street 1:1101 PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8016
Practice Address - Country:US
Practice Address - Phone:812-758-4071
Practice Address - Fax:812-205-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-04
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1055762A261QA1903X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100212490Medicaid
IN201070290AMedicaid
ININ1197Medicare PIN