1265434740 NPI number — SALLY K BALIN AMBULATORY SURGICAL CENTER INC

Table of content: (NPI 1265434740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265434740 NPI number — SALLY K BALIN AMBULATORY SURGICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALLY K BALIN AMBULATORY SURGICAL CENTER INC
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:
1265434740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 CHESLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-1755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-892-0300
Provider Business Mailing Address Fax Number:
610-565-9909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CHESLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-892-0300
Provider Business Practice Location Address Fax Number:
610-565-9909
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
610-565-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  09421500 , 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)





Copyright © 2007-2024 www.npivalidator.com