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NPI Code Detail

MEDICARE: LAUREL LASER & SURGERY CENTER, L.P.

MEDICARE: LAUREL LASER & SURGERY CENTER, L.P.
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
1261QA1903XAmbulatory Surgical Clinic/Center11351500PA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1490004660OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2216106OTHERPAUPMC
32326303OTHERAETNA
41343OTHERHIGHMARK BLUE CROSS BLUE
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6138792OTHERHEALTH AMERICA/ASSURANCE

General Provider Information

NPI Number : 1821093204
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAUREL LASER & SURGERY CENTER, L.P.
Provider Business Mailing Address
First Line : 52 WATERFORD PIKE
Second Line :
City : BROOKVILLE
State : PA
Zip : 15825-2518
Country : US
Telephone Number : 814-849-0898
Fax Number : 814-849-2890
Provider Business Practice Location Address
First Line : 52 WATERFORD PIKE
Second Line :
City : BROOKVILLE
State : PA
Zip : 15825-2518
Country : US
Telephone Number : 814-849-0898
Fax Number : 814-849-2890
Authorized Official
Title or Position : CLINICAL DIRECTOR / ADMINISTRATOR
Name : WHITNEY N SUTLEY
Credential : RN
Telephone Number : 814-849-6561
Provider Enumeration Date : 06/14/2005
Last Update Date : 06/10/2024

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