Provider Demographics
NPI:1508863242
Name:BUFFALO SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BUFFALO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LISS
Authorized Official - Last Name:ZIMDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RN, CNOR, CASC
Authorized Official - Phone:716-250-6520
Mailing Address - Street 1:3921 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1718
Mailing Address - Country:US
Mailing Address - Phone:716-250-6520
Mailing Address - Fax:716-250-6565
Practice Address - Street 1:3921 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1718
Practice Address - Country:US
Practice Address - Phone:716-250-6520
Practice Address - Fax:716-250-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401231R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030394701OtherUNIVERA
NY463OtherBLUE CROSS & BLUE SHIELDS
NYD2OtherINDEPENDENT HEALTH
NY00030394701OtherUNIVERA