Provider Demographics
NPI:1518004050
Name:SOUTH CENTRAL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SOUTH CENTRAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIR PRESIDENT MEDICAL STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-736-9355
Mailing Address - Street 1:5002 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-8578
Mailing Address - Country:US
Mailing Address - Phone:317-346-7272
Mailing Address - Fax:317-736-5157
Practice Address - Street 1:5002 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8578
Practice Address - Country:US
Practice Address - Phone:317-346-7272
Practice Address - Fax:317-736-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
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
IN000000208428OtherANTHEM PIN NUMBER
IN000000208428OtherANTHEM PIN NUMBER