Provider Demographics
NPI:1326132879
Name:NORTHWEST AMBULATORY SURGERY, LLC
Entity Type:Organization
Organization Name:NORTHWEST AMBULATORY SURGERY, LLC
Other - Org Name:CHANDANA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BEEKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT, CASC
Authorized Official - Phone:219-548-7483
Mailing Address - Street 1:1700 POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384
Mailing Address - Country:US
Mailing Address - Phone:219-476-0404
Mailing Address - Fax:219-548-8185
Practice Address - Street 1:1700 POINTE DRIVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46384
Practice Address - Country:US
Practice Address - Phone:219-476-0404
Practice Address - Fax:219-548-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
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
INZH1030Medicare ID - Type Unspecified