Healthcare Provider Details

I. General information

NPI: 1821093204
Provider Name (Legal Business Name): LAUREL LASER & SURGERY CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WATERFORD PIKE
BROOKVILLE PA
15825-2518
US

IV. Provider business mailing address

52 WATERFORD PIKE
BROOKVILLE PA
15825-2518
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-0898
  • Fax: 814-849-2890
Mailing address:
  • Phone: 814-849-0898
  • Fax: 814-849-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number11351500
License Number StatePA

VIII. Authorized Official

Name: WHITNEY N SUTLEY
Title or Position: CLINICAL DIRECTOR / ADMINISTRATOR
Credential: RN
Phone: 814-849-6561