Healthcare Provider Details

I. General information

NPI: 1033210760
Provider Name (Legal Business Name): CARLISLE ENDOSCOPY CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ALEXANDER SPRING RD
CARLISLE PA
17015-6953
US

IV. Provider business mailing address

241 ALEXANDER SPRING RD
CARLISLE PA
17015-6953
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-2228
  • Fax: 717-245-0806
Mailing address:
  • Phone: 717-245-2228
  • Fax: 717-245-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10101501
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier490005026
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE
# 2
Identifier0018390860001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ROBERT LEVY
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 717-245-2228