# HIGHLAND AMBULATORY SURGICAL CENTER, LLC

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

## Provider details

- **NPI number:** 1790739894
- **Authorized official:** KEITH R THOMAE M.D. (PRESIDENT)
- **Authorized official phone:** (618) 654-8100

## Contact information

- **Practice address:** 1212 BROADWAY, SUITE C, HIGHLAND, IL 62249-1960
- **Practice address phone:** (618) 654-8100
- **Practice address fax:** (618) 654-4563
- **Mailing address:** 1212 BROADWAY, SUITE C, HIGHLAND, IL 62249-1960
- **Mailing address phone:** (618) 654-8100
- **Mailing address fax:** (618) 654-4563

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 7002868 | IL | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 06/01/2010