Healthcare Provider Details

I. General information

NPI: 1487158796
Provider Name (Legal Business Name): CENTRIC AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 SILVA LN
MOBERLY MO
65270-3660
US

IV. Provider business mailing address

2103 SILVA LN
MOBERLY MO
65270-3660
US

V. Phone/Fax

Practice location:
  • Phone: 660-616-0022
  • Fax:
Mailing address:
  • Phone: 660-616-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJEEV DHARI RAVIPUDI
Title or Position: OWNER
Credential: MD
Phone: 626-394-6299