1649270075 NPI number — NORTHEAST REGIONAL SURGERY CENTER LLC

Table of content: (NPI 1649270075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649270075 NPI number — NORTHEAST REGIONAL SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST REGIONAL SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649270075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 GALLAGHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18705-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-970-1030
Provider Business Mailing Address Fax Number:
570-270-0577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 GALLAGHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-970-1030
Provider Business Practice Location Address Fax Number:
570-270-0577
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARDONI
Authorized Official First Name:
ROBINE
Authorized Official Middle Name:
SAUTASANIA
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
570-970-1030

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  17231501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84235 . This is a "GEISINGER PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 125451600 . This is a "DEPT OF LABOR PROVIDER NU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39C0001156 . This is a "STERLING PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 817821 . This is a "FIRST PRIORITY PROVIDER N" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1008875000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075544 . This is a "BLUE CROSS & WMC CHARGE M" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3346749 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000148664 . This is a "3 RIVERS/MED PLUS PROVIDE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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