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AMBULATORY SURGERY CENTER OF CENTRALIA LLC NPI 1265495824


NPI Information

NPI: 1265495824
Provider Name: AMBULATORY SURGERY CENTER OF CENTRALIA, LLC

Doing Business As: THE SURGERY CENTER OF CENTRALIA

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 15D1046650

Address:
1045 MARTIN LUTHER KING DR
CENTRALIA, IL
ZIP 62801
Phone: (618) 532-3110
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AMBULATORY SURGERY CENTER OF CENTRALIA, LLC is a clinic center in Centralia, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). AMBULATORY SURGERY CENTER OF CENTRALIA, LLC NPI is 1265495824. The provider is registered as an organization entity type.
The provider Is Doing Business As The Surgery Center Of Centralia.

The provider's business location address is:

1045 MARTIN LUTHER KING DR
CENTRALIA, IL
ZIP 62801-001
Phone: (618) 532-3110
Fax: (618) 532-3110

The provider's authorized official is Udaya Liyanage .
The authorized official title is President and has the following contact phone number (618) 899-9200.

The CLIA number assigned to this NPI record is 15D1046650 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/6/2006 and was last updated on 2/5/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1261Q00000XClinic/Center036065384ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
106130323OTHERBLUE CROSS BLUE SHIELD
2036065384MEDICAIDILLINOIS
3CH8278OTHERRR MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.