1265435176 NPI number — POCONO AMBULATORY SURGERY CENTER LTD

Table of content: (NPI 1265435176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265435176 NPI number — POCONO AMBULATORY SURGERY CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POCONO AMBULATORY SURGERY CENTER LTD
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:
1265435176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 VETERANS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18360-2418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-421-4978
Provider Business Mailing Address Fax Number:
570-424-7312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 VETERANS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-4978
Provider Business Practice Location Address Fax Number:
570-424-7312
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CONAHAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
570-421-4978

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  16821500 , 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: 075186 . This is a "FIRST PRIORITY HEALTH PRO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2175169 . This is a "UNITED HEALTHCARE PROVIDE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A1985647 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0078006230002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22777 . This is a "GEISINGER PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 78251 . This is a "MED PLUS PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 303901 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8496212 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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