MEDICARE: AMBULATORY SURGERY CENTER AT THE JEFFERSON PAIN & REHAB CENTER

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		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558613067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY SURGERY CENTER AT THE JEFFERSON PAIN & REHAB CENTER

Provider Business Mailing Address
First Line	:	4735 CLAIRTON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-2115
Country	:	US
Telephone Number	:	412-885-5400
Fax Number	:	412-885-1773

Provider Business Practice Location Address
First Line	:	4735 CLAIRTON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-2115
Country	:	US
Telephone Number	:	412-885-5400
Fax Number	:	412-885-1773

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/PRESIDENT
Name	:	DR. JOHN KEUN-SANG LEE
Credential	:	M.D.
Telephone Number	:	412-885-5400

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	01/20/2015

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