Provider Demographics
NPI:1225077373
Name:CARMEL AMBULATORY SURGERY CENTER,LLC
Entity Type:Organization
Organization Name:CARMEL AMBULATORY SURGERY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-1600
Mailing Address - Street 1:13421 OLD MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1427
Mailing Address - Country:US
Mailing Address - Phone:317-706-1600
Mailing Address - Fax:317-706-1601
Practice Address - Street 1:13421 OLD MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1427
Practice Address - Country:US
Practice Address - Phone:317-706-1600
Practice Address - Fax:317-706-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060034971261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200464700BMedicaid
IN200464700BMedicaid