Provider Demographics
NPI:1942292545
Name:CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANKAR
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-438-7638
Mailing Address - Street 1:1367 WASHINGTON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1043
Mailing Address - Country:US
Mailing Address - Phone:518-438-7638
Mailing Address - Fax:518-438-7695
Practice Address - Street 1:1367 WASHINGTON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1043
Practice Address - Country:US
Practice Address - Phone:518-438-7638
Practice Address - Fax:518-438-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0101220R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02137117Medicaid
NY02137117Medicaid