Provider Demographics
NPI:1750470530
Name:EVANSVILLE SURGERY CENTER ASSOCIATES, LLC
Entity Type:Organization
Organization Name:EVANSVILLE SURGERY CENTER ASSOCIATES, LLC
Other - Org Name:EVANSVILLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, MHA
Authorized Official - Phone:812-433-3166
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47728-0185
Mailing Address - Country:US
Mailing Address - Phone:812-428-0810
Mailing Address - Fax:812-428-2370
Practice Address - Street 1:4133 GATEWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8950
Practice Address - Country:US
Practice Address - Phone:812-858-4400
Practice Address - Fax:812-858-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
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
INZE2040Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER