1992768048 NPI number — LEBANON OUTPATIENT SURGICAL CENTER L.P.

Table of content: (NPI 1992768048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992768048 NPI number — LEBANON OUTPATIENT SURGICAL CENTER L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEBANON OUTPATIENT SURGICAL CENTER L.P.
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:
1992768048
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:
830 TUCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042-7477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-228-1620
Provider Business Mailing Address Fax Number:
717-228-1642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 TUCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-7477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-228-1620
Provider Business Practice Location Address Fax Number:
717-228-1642
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUHRMAN
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
717-228-1620

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  05781500 , 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: 718200 . This is a "HEALTH AMERICAHEALTH ASSU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001449984001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519405 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390708 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 501572 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1600 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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