PHYSICIANS SURGERY CENTER, LLC NPI 1023297553

Clinic/Center (Ambulatory Surgical) in Carbondale, IL

NPI 1023297553 Organization Clinic/Center Ambulatory Surgical CLIA Number 14D1077131 CLIA Certificate of Waiver

About PHYSICIANS SURGERY CENTER, LLC

Physicians Surgery Center, Llc is a provider established in Carbondale, Illinois specializing in clinic/center (ambulatory surgical) . The NPI number of Physicians Surgery Center, Llc is 1023297553 and was assigned on November 2007. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The authorized official of this NPI record is Dr. Sheffield Boardman M.d. (Medical Director)

The CLIA number of Physicians Surgery Center, Llc is 14D1077131 registered as a "ambulatory surgery center" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Physicians Surgery Center, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1023297553

Provider NamePHYSICIANS SURGERY CENTER, LLC
Provider Location Address2601 W MAIN ST CARBONDALE, IL 62901
Provider Mailing Address2601 W MAIN ST CARBONDALE, IL 62901
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date11-01-2007
Last Update Date06-21-2018


Primary Taxonomy

Taxonomy Code261QA1903X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationAmbulatory Surgical

Business Address

PHYSICIANS SURGERY CENTER, LLC
2601 W MAIN ST
CARBONDALE, IL
ZIP 62901
Phone: (618) 549-5361

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Mailing Address

PHYSICIANS SURGERY CENTER, LLC
2601 W MAIN ST
CARBONDALE, IL
ZIP 62901
Phone: (618) 549-5361



Authorized Official

Authorized Official NameDR. SHEFFIELD BOARDMAN M.D.
Authorized Official TitleMEDICAL DIRECTOR
Authorized Official Phone(618) 549-5361

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1023297553 is:

CLIA Number14D1077131
Facility TypeAMBULATORY SURGERY CENTER
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
=========OTHER (01)
50935OTHER (01)IL
878466OTHER (01)
=========OTHER (01)IL
328614OTHER (01)
014101OTHER (01)
=========OTHER (01)

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1295727006MS. CHRISTINE MARIE DAKIN CRNA
Individual
Nurse Anesthetist, Certified Registered2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1407822406DR. DAVID D CLUTTS M.D.
Individual
Surgery2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1609844927DR. SUSAN SCHABERG M.D.
Individual
Dermatology2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1184693160DR. RAMI ABDO MD
Individual
Internal Medicine2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1356355135DR. SHEFFIELD BOARDMAN M.D.
Individual
Internal Medicine (Gastroenterology)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1184737306DR. KATHRYN CHURLING M.D.
Individual
Pediatrics2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1477666394DR. HARK CHANG M.D.
Individual
Urology2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1952471310MS. ANN LIMEGROVER NP
Individual
Nurse Practitioner (Pediatrics)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1043378565THE CARBONDALE CLINIC
Organization
Clinic/Center (Multi-Specialty)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 457-5200
1326104290 MIKE STAFF PA
Individual
Physician Assistant2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1417013095CARBONDALE RURAL HEALTH CLINIC
Organization
Clinic/Center (Rural Health)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1679639561MS. BIANCA BOTTIAUX PA
Individual
Physician Assistant2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1710043435THE CARBONDALE CLINIC PHARMACY
Organization
Pharmacy (Community/Retail Pharmacy)2601 W MAIN ST SUITE 101
CARBONDALE, IL 62901
(618) 549-5361
1336205913CLINIC LABORATORY
Organization
Clinical Medical Laboratory2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1285790519THE CARBONDALE CLINIC RADIOLOGY
Organization
Radiology (Diagnostic Radiology)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 457-5200
1679639918THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER
Organization
Clinic/Center (Ambulatory Surgical)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1508913427MS. LORI TRENTACOSTI REGISTERED DIETICIAN
Individual
Dietitian, Registered2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1538292370FAIRVIEW HEIGHTS MEDICAL GROUP SC
Organization
Pediatrics (Pediatric Cardiology)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1093975419 SANDHYA RANI GRANDHI
Individual
Family Medicine2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361
1699052621PHYSICIANS SURGERY CENTER ANESTHESIA
Organization
Clinic/Center (Ambulatory Surgical)2601 W MAIN ST
CARBONDALE, IL 62901
(618) 549-5361

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.