Provider Demographics
NPI:1881294171
Name:ASC AT FHO
Entity type:Organization
Organization Name:ASC AT FHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBRODO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-452-5113
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-0189
Mailing Address - Country:US
Mailing Address - Phone:316-452-5113
Mailing Address - Fax:316-295-2682
Practice Address - Street 1:822 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9527
Practice Address - Country:US
Practice Address - Phone:316-247-5499
Practice Address - Fax:316-295-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical