MEDICARE: REDD ASC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1437875028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDD ASC LLC

Provider Business Mailing Address
First Line	:	1480-B REDD RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480-B REDD RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3026
Country	:	US
Telephone Number	:	915-600-2639
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCO ANTONIO GONZALEZ
Credential	:	MD
Telephone Number	:	915-600-2639

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	05/02/2024

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