Provider Demographics
NPI:1598804064
Name:MID-AMERICA SURGERY CENTER
Entity Type:Organization
Organization Name:MID-AMERICA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIRST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-284-0134
Mailing Address - Street 1:6004 W KILGORE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4726
Mailing Address - Country:US
Mailing Address - Phone:765-284-0134
Mailing Address - Fax:765-284-6770
Practice Address - Street 1:6004 W KILGORE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4726
Practice Address - Country:US
Practice Address - Phone:765-284-0134
Practice Address - Fax:765-284-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010353261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN25799Medicare UPIN