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General NPI Number Information
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NPI Number | 1194264036
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1018 E WHEATLAND RD
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4914
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Country | US
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Telephone | 972-646-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 E WHEATLAND RD
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4914
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Country | US
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Telephone | 972-646-1159
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | AMIT GUTTIGOLI
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Credential | MD
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Telephone | 469-358-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 130304
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License Number State | TX
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