1669647210 NPI number — SAINT VINCENT ENDOSCOPY CENTER LLC

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 1669647210 NPI number — SAINT VINCENT ENDOSCOPY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT VINCENT ENDOSCOPY 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:
1669647210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415357
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-589-9000
Provider Business Mailing Address Fax Number:
215-589-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 W 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16505-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-589-9000
Provider Business Practice Location Address Fax Number:
215-589-9030
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SABLYAK
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
215-589-9001

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82192 . This is a "AAAHC ACCREDITATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100246794 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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