| The Surgery Center Of Centralia | |
|
1045 Martin Luther King Dr Centralia IL 62801-3001 | |
| (618) 532-3110 | |
| (618) 532-3110 |
| Full Name | The Surgery Center Of Centralia |
|---|---|
| Speciality | Clinic/Center |
| Location | 1045 Martin Luther King Dr, Centralia, Illinois |
| Authorized Official Name and Position | Udaya Liyanage (PRESIDENT) |
| Authorized Official Contact | 6188999200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Surgery Center Of Centralia 1045 Martin Luther King Dr Centralia IL 62801-3001 Ph: (618) 532-3110 | The Surgery Center Of Centralia 1045 Martin Luther King Dr Centralia IL 62801-3001 Ph: (618) 532-3110 |
| NPI Number | 1265495824 |
|---|---|
| Provider Enumeration Date | 04/06/2006 |
| Last Update Date | 02/05/2024 |
| Medicare PECOS PAC ID | 1254343007 |
|---|---|
| Medicare Enrollment ID | O20060620000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265495824 | NPI | - | NPPES |
| 06130323 | Other | BLUE CROSS BLUE SHIELD | |
| 036065384 | Medicaid | IL | |
| CH8278 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036065384 (Illinois) | Primary |
| Provider Name | Bertha M Doss |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1386701795 PECOS PAC ID: 8820980527 Enrollment ID: I20040326001330 |
| Provider Name | Donald E Smith |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215035050 PECOS PAC ID: 6204820178 Enrollment ID: I20040413000982 |
| Provider Name | Joan A Potter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1841380508 PECOS PAC ID: 5991771669 Enrollment ID: I20040903000198 |
| Provider Name | Douglas L Mcdonald |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467462671 PECOS PAC ID: 7911904933 Enrollment ID: I20061103000212 |
| Provider Name | Julianna M Peters |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1568635605 PECOS PAC ID: 9032288477 Enrollment ID: I20080527000416 |
| Provider Name | Kyle T Griffith |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740260108 PECOS PAC ID: 6507872355 Enrollment ID: I20090604000473 |
| Provider Name | James Andrew Eads |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1659434710 PECOS PAC ID: 6103873963 Enrollment ID: I20091005000090 |
| Provider Name | Diana L Schuler |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1164796827 PECOS PAC ID: 9537322334 Enrollment ID: I20120514000759 |
| Provider Name | Holly A Wilke |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1386064996 PECOS PAC ID: 3173845302 Enrollment ID: I20141125001472 |
| Provider Name | Tyson Purchatzke |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1225427453 PECOS PAC ID: 1355666868 Enrollment ID: I20150204000605 |
| Provider Name | Corey M Bruff |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1841658200 PECOS PAC ID: 3375840325 Enrollment ID: I20160318001175 |
| Provider Name | Almedin Valjevcic |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1164970273 PECOS PAC ID: 6002191590 Enrollment ID: I20190730004493 |
| Provider Name | Richard G Ponder |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1366460750 PECOS PAC ID: 4587684030 Enrollment ID: I20201230002107 |
Tom Martin Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Ml King Dr, Suite 104, Centralia, IL 62801 Phone: 618-532-6330 Fax: 618-532-7227 | |
Heartland Women's Healthcare Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 430 N Pleasant Ave, Centralia, IL 62801 Phone: 618-997-5266 | |
Rajendra R Shroff Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 M L King Dr Ste 101, Centralia, IL 62801 Phone: 618-532-5700 | |
Stephen T Ang Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1054 Martin Luther King Dr, Ste 120, Centralia, IL 62801 Phone: 618-532-1688 Fax: 618-436-8081 | |
Dr Shrestha Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1050 M L King Dr, Suite 111, Centralia, IL 62801 Phone: 567-868-4507 Fax: 877-397-7287 | |
Ssm Health Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1441 W Broadway, Centralia, IL 62801 Phone: 618-532-9050 |