Healthcare Provider Details

I. General information

NPI: 1578525515
Provider Name (Legal Business Name): COLLEGE HEIGHTS ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 COLLEGE HEIGHTS BLVD
ALLENTOWN PA
18104-4813
US

IV. Provider business mailing address

3147 COLLEGE HEIGHTS BLVD
ALLENTOWN PA
18104-4813
US

V. Phone/Fax

Practice location:
  • Phone: 610-841-2432
  • Fax: 610-841-4433
Mailing address:
  • Phone: 610-841-2432
  • Fax: 610-841-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BOWYER
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 610-439-8551