1598773111 NPI number — SURGERY CENTER OF POTTSVILLE, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598773111 NPI number — SURGERY CENTER OF POTTSVILLE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF POTTSVILLE, LP
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:
SURGERY CENTER OF POTTSVILLE
Provider Other Organization Name Type Code:
3
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:
1598773111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1544 ROUTE 61
Provider Second Line Business Mailing Address:
SUITE 6192
Provider Business Mailing Address City Name:
POTTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-385-7000
Provider Business Mailing Address Fax Number:
570-385-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1544 ROUTE 61
Provider Second Line Business Practice Location Address:
SUITE 6192
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-7000
Provider Business Practice Location Address Fax Number:
570-385-7900
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-385-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  2110 , 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)





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