Healthcare Provider Details

I. General information

NPI: 1083008080
Provider Name (Legal Business Name): BEDFORD AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WASHINGTON PL
BEDFORD NH
03110-6743
US

IV. Provider business mailing address

11 WASHINGTON PL
BEDFORD NH
03110-6747
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3670
  • Fax:
Mailing address:
  • Phone: 603-234-4880
  • Fax: 603-626-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number02756
License Number StateNH

VIII. Authorized Official

Name: MR. NICHOLAS VAILAS
Title or Position: CEO
Credential:
Phone: 603-622-3670