MEDICARE: COLLEGE HEIGHTS ENDOSCOPY CENTER, LLC

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	207L00000X	Anesthesiology Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK8757	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	089900	OTHER	PA	AMERIHEALTH MERCY
3	1466649	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1578525515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEGE HEIGHTS ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	3147 COLLEGE HEIGHTS BLVD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-4813
Country	:	US
Telephone Number	:	610-841-2432
Fax Number	:	610-841-4433

Provider Business Practice Location Address
First Line	:	3147 COLLEGE HEIGHTS BLVD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-4813
Country	:	US
Telephone Number	:	610-841-2432
Fax Number	:	610-841-4433

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	VICTORIA BOWYER
Credential	:
Telephone Number	:	610-439-8551

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/20/2008

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