Provider Demographics
NPI:1154996361
Name:CHADDS FORD AMBULATORY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:CHADDS FORD AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:100 WILMINGTON W CHESTER PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9040
Mailing Address - Country:US
Mailing Address - Phone:610-672-4900
Mailing Address - Fax:
Practice Address - Street 1:100 WILMINGTON W CHESTER PIKE STE 100
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9040
Practice Address - Country:US
Practice Address - Phone:610-672-4900
Practice Address - Fax:913-685-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical