Healthcare Provider Details

I. General information

NPI: 1063466118
Provider Name (Legal Business Name): VALLEY SURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 FRITCH DRIVE
BETHLEHEM PA
18020
US

IV. Provider business mailing address

4250 FRITCH DRIVE
BETHLEHEM PA
18020
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-9040
  • Fax: 610-954-9093
Mailing address:
  • Phone: 610-954-9040
  • Fax: 610-954-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2068
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEVEN ALLIE MORTAZAVI
Title or Position: PRESIDENT
Credential: MD
Phone: 610-954-9040