Healthcare Provider Details

I. General information

NPI: 1134714918
Provider Name (Legal Business Name): VALLEY ACCESS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 CITY LINE ROAD SUITE 101
BETHLEHEM PA
18017-2167
US

IV. Provider business mailing address

2014 CITY LINE ROAD SUITE 101
BETHLEHEM PA
18017-2167
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5199
  • Fax:
Mailing address:
  • Phone: 610-264-5199
  • Fax:

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: RAVINDRA BOLLU
Title or Position: M.D.
Credential: M.D.
Phone: 610-264-5199