ADVANCED REGIONAL SURGERY CENTER, LLC - NPI NUMBER 1710231642

Summary

Provider Name: ADVANCED REGIONAL SURGERY CENTER, LLC

NPI Number: 1710231642

Clasification: Clinic/Center (261QA1903X)

Specialization: Ambulatory Surgical

Address:
360 MISSOURI AVE
BUILDING 19A
JEFFERSONVILLE, IN
ZIP 47130

Phone Number: (391) 626-4323



Detailed Information

ADVANCED REGIONAL SURGERY CENTER, LLC is an ambulatory surgical clinic/center in Jeffersonville, IN. The assigned NPI number for this provider is 1710231642 and is registered as an organization entity type.

The provider's business address is:

360 MISSOURI AVE
BUILDING 19A
JEFFERSONVILLE, IN
ZIP 47130
Phone: (391) 626-4323

The provider's authorized official is Teresa Hamrick .
The authorized official title is Rn and has the following contact phone number (931) 626-4323.

The enumeration date for this NPI number is 10/30/2012 and was last updated on 10/30/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QA1903X Clinic/Center Ambulatory Surgical Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1710231642 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name ADVANCED REGIONAL SURGERY CENTER, LLC Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
5 Provider First Line Business Practice Location Address 360 MISSOURI AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address BUILDING 19A The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name JEFFERSONVILLE The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name IN The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 47130 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 3916264323 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 10/30/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 10/30/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name HAMRICK The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name TERESA The first name of the authorized official.
16 Authorized Official Title or Position RN The title or position of the authorized official.
17 Authorized Official Telephone Number 9316264323 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 261QA1903X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart N
21 Authorized Official Credential Text CLINICAL COORDINATOR

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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