MEDICARE: JASPER 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1730842311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASPER SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1101 OLD PHILADELPHIA RD STE G200
Second Line	:
City	:	JASPER
State	:	GA
Zip	:	30143-4044
Country	:	US
Telephone Number	:	205-422-5189
Fax Number	:	833-989-2501

Provider Business Practice Location Address
First Line	:	1101 OLD PHILADELPHIA RD STE G200
Second Line	:
City	:	JASPER
State	:	GA
Zip	:	30143-4044
Country	:	US
Telephone Number	:	205-422-5189
Fax Number	:	833-989-2501

Authorized Official
Title or Position	:	OWNER
Name	:	ANKUR PATEL
Credential	:	DO
Telephone Number	:	205-422-5189

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	03/18/2022

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