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General NPI Number Information
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NPI Number | 1689393746
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Entity Type | Organization
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Legal Business Name | ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1619 SKYLINE CIRCLE SUITE B
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City | CARLSBAD
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State | NM
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Zip | 88220-3513
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Country | US
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Telephone | 575-202-0630
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Fax | 888-572-7765
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Provider Business Mailing Address
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Address Line | 1619 SKYLINE CIRCLE SUITE B
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City | CARLSBAD
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State | NM
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Zip | 88220-3513
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Country | US
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Telephone | 575-202-0630
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Fax | 888-572-7765
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | TAMI LYNN WACKER
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Credential |
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Telephone | 575-302-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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