# SALEM ASC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104415702
- **Authorized official:** MR. WILLIAM JUDE COLGAN (OWNER/MANAGING PARTNER)
- **Authorized official phone:** (856) 434-7573

## Contact information

- **Practice address:** 336 SALEM WOODSTOWN RD, SALEM, NJ 08079-2027
- **Practice address phone:** (856) 434-7573
- **Mailing address:** PO BOX 7096, STOCKTON, CA 95267-0096
- **Mailing address phone:** (209) 956-7725
- **Mailing address fax:** (209) 956-7733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/18/2021
- **Last updated:** 01/18/2021