1134114119 NPI number — EVANGELICAL AMBULATORY SURGICAL CENTER, LLC

Table of content: (NPI 1134114119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134114119 NPI number — EVANGELICAL AMBULATORY SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANGELICAL AMBULATORY SURGICAL 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:
1134114119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 JPM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-9367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-524-6700
Provider Business Mailing Address Fax Number:
570-524-6710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 JPM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-9367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-6700
Provider Business Practice Location Address Fax Number:
570-524-6710
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MALONEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
570-524-6700

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  14631501 , 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: 1007755680001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20025739 . This is a "AMERIHEALTH PROVIDER NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39C0001119 . This is a "STERLING OPTION I" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 79197 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0167726 . This is a "DEPARTMENT OF LABOR PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 155458XX . This is a "PREFERRED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 151805 . This is a "HEALTH AMERICA PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390839 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1599 . This is a "HIGHMARK BLUESHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 490005320 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com