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General NPI Number Information
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NPI Number | 1992178578
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Entity Type | Organization
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Legal Business Name | ADVANCED AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 400 W I ST SUITE E
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City | LOS BANOS
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State | CA
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Zip | 93635-3459
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Country | US
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Telephone | 209-489-9110
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Fax | 209-826-0199
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Provider Business Mailing Address
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Address Line | 1500 HILLVIEW DR
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City | LOS BANOS
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State | CA
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Zip | 93635-4705
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Country | US
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Telephone | 209-489-9110
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Fax | 209-826-0199
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARTHIKEYA DEVIREDDY
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Credential | M.D.
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Telephone | 209-489-9110
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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 | CA
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