Provider Demographics
NPI:1588046361
Name:NIAGARA ASC, LLC
Entity type:Organization
Organization Name:NIAGARA ASC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLONE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RN,
Authorized Official - Phone:585-233-0722
Mailing Address - Street 1:6500 PORTER RD
Mailing Address - Street 2:SUITE 2030
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1529
Mailing Address - Country:US
Mailing Address - Phone:716-285-2020
Mailing Address - Fax:716-285-2060
Practice Address - Street 1:6500 PORTER RD
Practice Address - Street 2:SUITE 2030
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1529
Practice Address - Country:US
Practice Address - Phone:716-285-2020
Practice Address - Fax:716-285-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical