Provider Demographics
NPI:1437517745
Name:PREMIER AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:PREMIER AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-348-2759
Mailing Address - Street 1:5844 SOUTHWESTERN BLVD - SUITE 700
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3685
Mailing Address - Country:US
Mailing Address - Phone:716-348-2759
Mailing Address - Fax:716-646-5502
Practice Address - Street 1:5844 SOUTHWESTERN BLVD - SUITE 700
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3685
Practice Address - Country:US
Practice Address - Phone:716-348-2759
Practice Address - Fax:716-646-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677585Medicaid
NYJ400002142Medicare PIN