MEDICARE: SOUTHWEST AMBULATORY SURGERY CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1790493641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST AMBULATORY SURGERY CENTER, PLLC

Provider Business Mailing Address
First Line	:	1508 N ZARAGOZA RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8034
Country	:	US
Telephone Number	:	915-373-9066
Fax Number	:	915-298-5430

Provider Business Practice Location Address
First Line	:	3030 GATEWAY BLVD E
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-1014
Country	:	US
Telephone Number	:	915-373-9066
Fax Number	:	915-298-5430

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. CHIKEZIE CHIDIEBERE AMADI
Credential	:	M.D.
Telephone Number	:	915-373-9066

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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