Organization
AMBULATORY SURGERY CENTER OF CENTRALIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UDAYA LIYANAGE (PRESIDENT)
(618) 899-9200
Entity
Organization
Contact information
Practice address
1045 M L KING DR, CENTRALIA, IL 62801-3001
(618) 532-3110
Mailing address
1307 E MCCORD ST, CENTRALIA, IL 62801-3610
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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