Four Corners Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

6701 Issued in NM

Legal business name

FOUR CORNERS AMBULATORY SURGERY CENTER, LLC

Practice address

2300 E 30TH St BLDG a
Farmington, NM 87401-8991

Phone

(505) 564-2300

Fax

(505) 564-2210

NPI assigned

Nov 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Charles Redwing, FACMPE

Title

Executive Director

Phone

(505) 564-2300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Listed as

Four Corners Ambulatory Surgery Center LLCCCN 32C0001101

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Orthopedic Associates PA

  • Orthopaedic Surgery Physician
  • Farmington, NM
  • NPI 1750356820

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1104990050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 E 30TH ST BLDG A",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874018991",
            "telephone_number": "505-564-2300",
            "fax_number": "505-564-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 E 30TH ST BLDG A",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874018991",
            "telephone_number": "505-564-2300",
            "fax_number": "505-564-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "REDWING",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "505-564-2300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FACMPE"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NM",
            "license": "6701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S7971",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Enola Ford
• Carrie Lucinda Forth
• Terri Dawn Fortner, PMHNP-BC
• Tanner Foster
• Founders Healthcare, LLC
• Four Corners Anesthesia, P.a.
• Four Corners Artificial Limb & Brace
• Four Corners Compounding
• Four Corners Family Dental LLC
• Four Corners Foot and Ankle P.C.

• Ambulatory Surgical Clinic/Center in Farmington, NM
• Providers in Farmington, NM by specialty
• Ambulatory Surgical Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.