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General NPI Number Information
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NPI Number | 1730842311
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Entity Type | Organization
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Legal Business Name | JASPER SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 1101 OLD PHILADELPHIA RD STE G200
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City | JASPER
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State | GA
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Zip | 30143-4044
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Country | US
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Telephone | 205-422-5189
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Fax | 833-989-2501
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Provider Business Mailing Address
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Address Line | 1101 OLD PHILADELPHIA RD STE G200
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City | JASPER
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State | GA
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Zip | 30143-4044
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Country | US
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Telephone | 205-422-5189
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Fax | 833-989-2501
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Authorized Official
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Title or Position | OWNER
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Name | ANKUR PATEL
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Credential | DO
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Telephone | 205-422-5189
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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 |
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License Number State |
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