Organization
AMBULATORY SURGERY CENTER OF CENTRALIA, LLC
Active
Other names
Surgery Center of Centralia Anesthesia, The Surgery Center of Centralia
Organization subpart
No
Provider details
NPI number
Authorized official
UDAYA LIYANAGE MD (PRESIDENT)
(618) 899-9200
Entity
Organization
Contact information
Practice address
1045 MARTIN LUTHER KING DR, CENTRALIA, IL 62801-3001
(618) 532-3110
(618) 532-3110
Mailing address
1045 MARTIN LUTHER KING DR, CENTRALIA, IL 62801-3001
(618) 532-3110
(618) 532-7226
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036065384
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065384
—
IL
01
—
06130323
BLUE CROSS BLUE SHIELD
—
01
—
CH8278
RR MEDICARE
—
Enumeration date
04/06/2006
Last updated
02/05/2024
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