Provider Demographics
NPI:1083008080
Name:BEDFORD AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:BEDFORD AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:BASC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-622-3670
Mailing Address - Street 1:11 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6747
Mailing Address - Country:US
Mailing Address - Phone:603-234-4880
Mailing Address - Fax:603-626-9750
Practice Address - Street 1:20 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6743
Practice Address - Country:US
Practice Address - Phone:603-622-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02756261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology