Basic Information
| Provider Information | |||||||||
| NPI: | 1447612114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LPC SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 PARK EAST BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479050786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657144344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 PARK EAST BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479050786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657144344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | SIDDIQUI | ||||||||
| AuthorizedOfficialFirstName: | SHAZIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7657144344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 01059790A | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.