Healthcare Provider Details

I. General information

NPI: 1558540922
Provider Name (Legal Business Name): BEAVER VALLEY OFFICE BASED SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 BRODHEAD RD SUITE B
ALIQUIPPA PA
15001-1370
US

IV. Provider business mailing address

3153 BRODHEAD RD SUITE B
ALIQUIPPA PA
15001-1370
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-2177
  • Fax: 724-774-1998
Mailing address:
  • Phone: 724-774-2177
  • Fax: 724-774-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HECTOR C. PAGAN
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 724-774-2177