Provider Demographics
NPI:1528197191
Name:RWMC AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RWMC AMBULATORY SURGERY CENTER, LLC
Other - Org Name:SCOTTSBLUFF SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-635-2588
Mailing Address - Street 1:4022 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4651
Mailing Address - Country:US
Mailing Address - Phone:308-633-6000
Mailing Address - Fax:308-633-6001
Practice Address - Street 1:4022 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4651
Practice Address - Country:US
Practice Address - Phone:308-633-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025556700Medicaid
NE099999Medicare PIN