Provider Demographics
NPI:1992178578
Name:ADVANCED AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:ADVANCED AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARTHIKEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-489-9110
Mailing Address - Street 1:1500 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4705
Mailing Address - Country:US
Mailing Address - Phone:209-489-9110
Mailing Address - Fax:209-826-0199
Practice Address - Street 1:400 W I ST
Practice Address - Street 2:SUITE E
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3459
Practice Address - Country:US
Practice Address - Phone:209-489-9110
Practice Address - Fax:209-826-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical