Provider Demographics
NPI:1205364981
Name:MERCED AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MERCED AMBULATORY SURGERY CENTER, LLC
Other - Org Name:UNIVERSITY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:1390 EAST YOSEMITE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-580-3400
Mailing Address - Fax:209-580-3450
Practice Address - Street 1:1390 E YOSEMITE AVE STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-580-3409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical