Healthcare Provider Details

I. General information

NPI: 1033426580
Provider Name (Legal Business Name): ADVANCED AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL BLVD STE 104
EVANSVILLE IN
47714-8018
US

IV. Provider business mailing address

1101 PROFESSIONAL BLVD SUITE 104
EVANSVILLE IN
47714-8016
US

V. Phone/Fax

Practice location:
  • Phone: 812-758-4071
  • Fax: 812-205-2654
Mailing address:
  • Phone: 812-758-4071
  • Fax: 812-205-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1055762A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CARRIE STRAW
Title or Position: BILLING
Credential:
Phone: 812-758-4034