AMBULATORY SURGERY CENTER OF CENTRALIA, LLC (NPI# 1811957251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811957251 |
| Entity Type | Organization |
| Organization Name | AMBULATORY SURGERY CENTER OF CENTRALIA, LLC |
| Other Organization Name | SURGERY CENTER OF CENTRALIA |
| Practice Address |
1045 M L King Dr Centralia IL 62801-3001 |
| Practice Telephone | 6185323110 |
| Practice Fax Number | 6185327226 |
| Mailing Telephone | 6185323110 |
| Mailing Fax Number | 6185327226 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2020-08-22 |
| 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 | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UMWA | 1542366 | 01 | |
| HEALTHLINK | 399431 | 01 |
| Other Name | Type Code |
|---|---|
| Surgery Center of Centralia | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265495824 | Ambulatory Surgery Center of Centralia, LLC | Clinic/Center | 1045 Martin Luther King Dr, Centralia, IL 62801-3001 | 2006-04-06 |
| Street Address |
1045 M L KING DR |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013148808 | Lees Anesthesia Services PC | Nurse Anesthetist, Certified Registered | 1045 M L King Dr, Centralia, IL 62801-3001 | 2009-07-28 |
| 1821040122 | David Earl Lees | Nurse Anesthetist, Certified Registered | 1045 M L King Dr, Centralia, IL 62801-3001 | 2006-05-16 |
| 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 | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962675520 | Fasa Family Wellness, Pllc | Clinic/Center | 1220 W 1st St, Suite B, Centralia, WA 98531-3018 | 2008-04-03 |
| 1134218167 | Washington Orthopaedic Center, Inc, Ps | Clinic/Center | 1900 Cooks Hill Rd, Centralia, WA 98531 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184245375 | Specialty Surgicare, Ltd | Clinic/Center | 500 W Golf Rd Ste 102, Schaumburg, IL 60195-3503 | 2020-04-29 |
| 1245862002 | Quincy Physicians & Surgeons Clinic, Sc | Clinic/Center | 3301 Broadway St., Quincy, IL 62301 | 2020-02-10 |
| 1619519535 | Anderson Surgery Center LLC | Clinic/Center | 3403 Anderson Healthcare Drive, Edwardsville, IL 62025 | 2019-10-11 |
| 1922664622 | Premier Cardiac Surgery Center, LLC | Clinic/Center | 11560 S Kedzie Ave Ste 102, Merrionette Park, IL 60803-4517 | 2019-05-17 |
| 1487115804 | Ontario Street Operatory Fac | Clinic/Center | 22 W Ontario Street Operatory, Chicago, IL 60654 | 2019-03-28 |
| 1477017333 | Ontario Street Operatory | Clinic/Center | 22 W Ontario St, Chicago, IL 60654-5169 | 2019-01-24 |
| 1407329501 | Chicago Cosmetic Surgery Institute | Clinic/Center | 2335 S Michigan Ave, Chicago, IL 60616-2104 | 2019-01-10 |
| 1538647474 | Palos Health Surgery Center, LLC | Clinic/Center | 15300 West Ave Ste 260, Orland Park, IL 60462-4600 | 2018-08-02 |
| 1013493824 | Ann & Robert H. Lurie Children's Hospital of Chicago | Clinic/Center | 1121 Techny Rd, Northbrook, IL 60062-5503 | 2018-07-15 |
| 1619469244 | Rush Oak Brook Surgery Center, LLC | Clinic/Center | 2011 York Road, Suite 3000, Oak Brook, IL 60521 | 2018-05-30 |
| 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.