# AMBULATORY SURGERY CENTER OF CENTRALIA

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

## Provider details

- **NPI number:** 1508574518
- **Authorized official:** UDAYA LIYANAGE (PRESIDENT)
- **Authorized official phone:** (618) 899-9200

## Contact information

- **Practice address:** 1045 M L KING DR, CENTRALIA, IL 62801-3001
- **Practice address phone:** (618) 532-3110
- **Mailing address:** 1307 E MCCORD ST, CENTRALIA, IL 62801-3610

## Taxonomy

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

## Other

- **Enumeration date:** 11/08/2022
- **Last updated:** 11/08/2022