Provider Demographics
NPI:1114696234
Name:ONE NINETEEN GI ASC, LLC
Entity Type:Organization
Organization Name:ONE NINETEEN GI ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DASHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-639-2871
Mailing Address - Street 1:1550 W MCEWEN DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1792
Mailing Address - Country:US
Mailing Address - Phone:817-343-2859
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:817-343-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical