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Get Asc Application Initial - Alaska Department Of Health And Social ...

YOU WILL BE ABLE TO SAVE THE FORM ONCE FILLED OUT. Department Use Only License Number Pursuant to the AS 47.32 Licensing Statute and the regulations of the Department of Health & Social Services Ambulatory Surgical Center (ASC) Licensing requirements (7 AAC 10 and 7 AAC 12). I. NAME AND LOCATION OF THE ASC Exact Legal Name: Doing Business As: Street and Number: City State Zip Code Premises Located At: Main Phone Number for Public Use: Administration Phone Number for HFL.

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