1821093204 NPI number — LAUREL LASER & SURGERY CENTER, L.P.

Table of content: (NPI 1821093204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821093204 NPI number — LAUREL LASER & SURGERY CENTER, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL LASER & SURGERY CENTER, L.P.
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:
1821093204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 WATERFORD PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15825-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-849-0898
Provider Business Mailing Address Fax Number:
814-849-2890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 WATERFORD PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15825-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-849-0898
Provider Business Practice Location Address Fax Number:
814-849-2890
Provider Enumeration Date:
06/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUCHANAN
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
814-849-0898

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  11351500 , 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: 138792 . This is a "HEALTH AMERICA/ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2326303 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1343 . This is a "HIGHMARK BLUE CROSS BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 216106 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".