Provider Demographics
NPI:1487018412
Name:DECATUR AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:DECATUR AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BABU
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-340-1212
Mailing Address - Street 1:2828 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1510
Mailing Address - Country:US
Mailing Address - Phone:256-340-1212
Mailing Address - Fax:256-340-0252
Practice Address - Street 1:2828 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1510
Practice Address - Country:US
Practice Address - Phone:256-340-1212
Practice Address - Fax:256-340-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty