1245233410 NPI number — SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC

Table of content: (NPI 1245233410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245233410 NPI number — SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, 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:
1245233410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD # L&C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-240-3820
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 WELLES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTY FORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-331-7615
Provider Business Practice Location Address Fax Number:
570-331-7614
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  148601 , 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: 814135 . This is a "FIRST PRIORITY HEALTH PRO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 127866 . This is a "MED PLUS/3 RIVERS PROVIDE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2139542 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 991073 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 077861 . This is a "AMERIHEALTH PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0198 . This is a "FREEDOM BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 49005260 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A2738987 . This is a "OXFORD PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 68929 . This is a "GEISINGER PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: IY0345 . This is a "HEALTH NET PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018825790001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2670019 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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