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

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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
1 NPI 1710231642
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name ADVANCED REGIONAL SURGERY CENTER, LLC
5 Provider First Line Business Practice Location Address 360 MISSOURI AVE
6 Provider Second Line Business Practice Location Address BUILDING 19A
7 Provider Business Practice Location Address City Name JEFFERSONVILLE
8 Provider Business Practice Location Address State Name IN
9 Provider Business Practice Location Address Postal Code 47130
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 3916264323
12 Provider Enumeration Date 10/30/2012
13 Last Update Date 10/30/2012
14 Authorized Official Last Name HAMRICK
15 Authorized Official First Name TERESA
16 Authorized Official Title or Position RN
17 Authorized Official Telephone Number 9316264323
18 Healthcare Provider Taxonomy Code 1 261QA1903X
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: 8/12/2014
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