Provider Demographics
NPI:1689393746
Name:ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, LLC
Entity type:Organization
Organization Name:ADVANCED AMBULATORY SURGERY CENTER OF CARLSBAD NM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-302-1666
Mailing Address - Street 1:1619 SKYLINE CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3513
Mailing Address - Country:US
Mailing Address - Phone:575-202-0630
Mailing Address - Fax:888-572-7765
Practice Address - Street 1:1619 SKYLINE CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3513
Practice Address - Country:US
Practice Address - Phone:575-202-0630
Practice Address - Fax:888-572-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty