Provider Demographics
NPI:1558328518
Name:BUTLER AMBULATORY SURGERY CENTER L L C
Entity Type:Organization
Organization Name:BUTLER AMBULATORY SURGERY CENTER L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:W
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-431-0750
Mailing Address - Street 1:102 TECHNOLOBY DRIVE SUITE 130
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-431-0740
Mailing Address - Fax:724-431-0759
Practice Address - Street 1:102 TECHNOLOBY DRIVE SUITE 130
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-431-0740
Practice Address - Fax:724-431-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20311501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016010080001Medicaid
PA101110Medicare PIN
PA39C00012010Medicare ID - Type Unspecified