Basic Information
| Provider Information | |||||||||
| NPI: | 1497782833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARMEL AMBULATORY SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13421 OLD MERIDIAN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177061600 | ||||||||
| FaxNumber: | 3177061601 | ||||||||
| Practice Location | |||||||||
| Address1: | 13421 OLD MERIDIAN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177061600 | ||||||||
| FaxNumber: | 3177061601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 12/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | BODEN | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3177061611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 06-003497-1 | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | P00086251 | 01 | IN | RAILROAD MEDICARE | OTHER | 200464700B | 05 | IN | MEDICAID |