Healthcare Provider Details

I. General information

NPI: 1932153459
Provider Name (Legal Business Name): FOUR SEASONS ENDOSCOPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KNOWLSON AVE
BEAVER FALLS PA
15010-1634
US

IV. Provider business mailing address

100 KNOWLSON AVE
BEAVER FALLS PA
15010-1634
US

V. Phone/Fax

Practice location:
  • Phone: 724-891-2100
  • Fax: 724-891-2734
Mailing address:
  • Phone: 724-891-2100
  • Fax: 724-891-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN ADAM CONNELLY
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 724-891-2100