Healthcare Provider Details

I. General information

NPI: 1043955305
Provider Name (Legal Business Name): GPS CRANBERRY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 DUTILH RD STE 100
CRANBERRY TOWNSHIP PA
16066-4148
US

IV. Provider business mailing address

1 PARKWAY NORTH BLVD STE 200S
DEERFIELD IL
60015-2532
US

V. Phone/Fax

Practice location:
  • Phone: 877-658-6800
  • Fax:
Mailing address:
  • Phone: 847-949-3855
  • Fax: 833-739-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JASON LOHMEYER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 847-949-3855