Provider Demographics
NPI:1124125331
Name:AMBULATORY SURGERY ASSOCIATES, LLC
Entity type:Organization
Organization Name:AMBULATORY SURGERY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-979-2490
Mailing Address - Street 1:3600 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-979-2490
Mailing Address - Fax:269-979-2690
Practice Address - Street 1:3600 CAPITAL AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9393
Practice Address - Country:US
Practice Address - Phone:269-979-2490
Practice Address - Fax:269-979-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40367OtherBX FACILITY NUMBER
MI=========Medicare UPIN
MIOM51860Medicare ID - Type UnspecifiedMEDICARE FACILITY NUMBER