MEDICARE: MIDLAND AMBULATORY SURGERY CENTER, 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	207R00000X	Internal Medicine Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1558857177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLAND AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	2106 N MIDLAND DR STE 100
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5503
Country	:	US
Telephone Number	:	432-423-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 N MIDLAND DR STE 100
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5503
Country	:	US
Telephone Number	:	432-423-2272
Fax Number	:

Authorized Official
Title or Position	:	OFFICER / AO
Name	:	AMANDA PEEKS
Credential	:
Telephone Number	:	806-570-7276

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	03/11/2026

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