Organization
AMBULATORY SURGERY CENTER OF CENTRALIA, LLC
Active
Other names
Surgery Center of Centralia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY L STOCKARD (VP COO)
(615) 377-5353
Entity
Organization
Contact information
Practice address
1045 M L KING DR, CENTRALIA, IL 62801-3001
(618) 532-3110
(618) 532-7226
Mailing address
1045 M L KING DR, CENTRALIA, IL 62801-3001
(618) 532-3110
(618) 532-7226
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1542366
UMWA
—
01
—
399431
HEALTHLINK
—
Enumeration date
03/27/2006
Last updated
08/22/2020
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