# EDWARDSVILLE AMBULATORY SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1952464844
- **Authorized official:** LAURA J FEY (SR. DIRECTOR PHYSICIAN REV CYCLE)
- **Authorized official phone:** (615) 221-3641

## Contact information

- **Practice address:** 12 GINGER CREEK PKWY, GLEN CARBON, IL 62034-3502
- **Practice address phone:** (618) 656-8200
- **Mailing address:** 1573 MALLORY LN STE 100, BRENTWOOD, TN 37027-2895
- **Mailing address phone:** (152) 221-1400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 7002504 | IL | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 07/07/2023