MEDICARE: GREECE 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	:	1780206292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREECE ASC, LLC

Provider Business Mailing Address
First Line	:	2300 BUFFALO RD BLDG 700
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1367
Country	:	US
Telephone Number	:	585-328-0153
Fax Number	:	585-328-1554

Provider Business Practice Location Address
First Line	:	135 CANAL LANDING BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5104
Country	:	US
Telephone Number	:	585-328-0153
Fax Number	:	585-328-0158

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE B PARK
Credential	:	MD
Telephone Number	:	585-328-0153

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/29/2020

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