Healthcare Provider Details

I. General information

NPI: 1730286097
Provider Name (Legal Business Name): PLYMOUTH MEETING AMBULATORY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W RIDGE PIKE BLDG B
CONSHOHOCKEN PA
19428-1191
US

IV. Provider business mailing address

625 W RIDGE PIKE BLDG B
CONSHOHOCKEN PA
19428-1191
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-9700
  • Fax: 610-834-9992
Mailing address:
  • Phone: 610-834-9700
  • Fax: 610-834-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number07451500
License Number StatePA

VIII. Authorized Official

Name: MS. DONNA MARIE COVELY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 610-834-9700