Healthcare Provider Details

I. General information

NPI: 1972508174
Provider Name (Legal Business Name): VILLAGE SURGICENTER, LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 VILLAGE COMMON DR STE 100
ERIE PA
16506-4961
US

IV. Provider business mailing address

5473 VILLAGE COMMON DR STE 100
ERIE PA
16506-4961
US

V. Phone/Fax

Practice location:
  • Phone: 814-836-0770
  • Fax: 814-836-0771
Mailing address:
  • Phone: 814-836-0770
  • Fax: 814-836-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number11001500
License Number StatePA

VIII. Authorized Official

Name: JENNIFER B. BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954