AMBULATORY SURGERY CENTER OF CENTRALIA, LLC (NPI# 1265495824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265495824 |
| Entity Type | Organization |
| Organization Name | AMBULATORY SURGERY CENTER OF CENTRALIA, LLC |
| Other Organization Name | SURGERY CENTER OF CENTRALIA ANESTHESIA |
| Practice Address |
1045 Martin Luther King Dr Centralia IL 62801-3001 |
| Practice Telephone | 6185323110 |
| Practice Fax Number | 6185323110 |
| Mailing Telephone | 6185323110 |
| Mailing Fax Number | 6185327226 |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MR. JEFFREY L STOCKARD (VP COO) |
| Authorized Official Telephone | 6153775353 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 036065384 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD | 06130323 | 01 | |
| IL | 036065384 | 05 | |
| RR MEDICARE | CH8278 | 01 |
| Other Name | Type Code |
|---|---|
| Surgery Center of Centralia Anesthesia | Other Name - Individual/Organization |
| The Surgery Center of Centralia | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811957251 | Ambulatory Surgery Center of Centralia, LLC | Clinic/Center | 1045 M L King Dr, Centralia, IL 62801-3001 | 2006-03-27 |
| Street Address |
1045 MARTIN LUTHER KING DR |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366410292 | Ghulam A Merchant | Anesthesiology | 1045 Martin Luther King Dr, Centralia, IL 62801-3001 | 2006-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| 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). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124117197 | Providence Health & Service Washington | Clinic/Center | 1010 South Scheuber Rd, Suites 3 & 4, Centralia, WA 98531-8892 | 2006-10-11 |
| 1598254617 | Absolute Health International Inc | Clinic/Center | 2020 Borst Ave, Centralia, WA 98531-1404 | 2018-05-03 |
| 1790037224 | Star Medical Clinic Inc. | Clinic/Center | 1217 Mellen St, Centralia, WA 98531-1175 | 2012-10-08 |
| 1699045740 | Dr Shrestha Md Sc | Clinic/Center | 1050 M L King Dr, Suite 111, Centralia, IL 62801-3060 | 2012-01-06 |
| 1932397510 | My Urban Clinic, Inc | Clinic/Center | 817 E Mccord, Centralia, IL 62801 | 2007-10-09 |
| 1689873937 | Providence Health & Services Washington | Clinic/Center | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2007-07-17 |
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| 1588261770 | Mount Sinai Community Foundation Dba Sinai Medical Group | Clinic/Center | 2701 W 68th St Fl 3, Chicago, IL 60629-1813 | 2020-10-01 |
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| 1821607425 | Desired Medical Services Incorporated | Clinic/Center | 371 Mackinaw Ave, Calumet City, IL 60409-2524 | 2020-07-29 |
| 1639787823 | Md Infusions, Pllc | Clinic/Center | 666 Dundee Rd Ste 1800, Northbrook, IL 60062-2727 | 2020-07-14 |
| 1407474083 | Staten Family Practice Pllc | Clinic/Center | 500 W Virginia Ave, Gillespie, IL 62033-1025 | 2020-07-09 |
| 1629696679 | Serenity Internal Medicine & Wellness Center | Clinic/Center | 3330 W 177th St # 2d-1, Hazel Crest, IL 60429-2184 | 2020-07-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.