MEDICARE: POCONO AMBULATORY SURGERY CENTER LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	16821500	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	075186	OTHER	PA	FIRST PRIORITY HEALTH PRO
2	2175169	OTHER	PA	UNITED HEALTHCARE PROVIDE
3	A1985647	OTHER	PA	OXFORD PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	22777	OTHER	PA	GEISINGER PROVIDER NUMBER
6	78251	OTHER	PA	MED PLUS PROVIDER NUMBER
7	303901	OTHER	PA	BLUE CROSS PROVIDER NUMBE
8	8496212	OTHER	PA	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1265435176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO AMBULATORY SURGERY CENTER LTD

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

Provider Business Practice Location Address
First Line	:	1 VETERANS PL
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-2418
Country	:	US
Telephone Number	:	570-421-4978
Fax Number	:	570-424-7312

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. JOSEPH B CONAHAN
Credential	:	M.D.
Telephone Number	:	570-421-4978

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/24/2008

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Directions to “POCONO AMBULATORY SURGERY CENTER LTD ” Practice Location

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