Provider Demographics
NPI:1124005558
Name:SURGICENTER GROUP, LLC
Entity Type:Organization
Organization Name:SURGICENTER GROUP, LLC
Other - Org Name:LAFAYETTE AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCRIPTURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-966-1945
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0472
Mailing Address - Country:US
Mailing Address - Phone:765-286-8888
Mailing Address - Fax:765-747-7962
Practice Address - Street 1:3733 ROME DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4490
Practice Address - Country:US
Practice Address - Phone:765-449-5272
Practice Address - Fax:765-447-8723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INZL7000Medicare ID - Type Unspecified