Organization
AMBULATORY SURGERY CENTER LLC
Active
Other names
AMBULATORY SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
LAXMAIAH MANCHIKANTI M.D. (MEDICAL DIRECTOR)
(270) 554-8373
Entity
Organization
Contact information
Practice address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Mailing address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
3600098
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36000909
—
KY
Enumeration date
02/09/2006
Last updated
10/05/2011
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