Healthcare Provider Details

I. General information

NPI: 1821098443
Provider Name (Legal Business Name): HAZLETON AMBULATORY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 N CHURCH ST
HAZLETON PA
18202-1444
US

IV. Provider business mailing address

1062 N CHURCH ST
HAZLETON PA
18202-1444
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-5102
  • Fax: 570-459-9923
Mailing address:
  • Phone: 570-459-5102
  • Fax: 570-459-9923

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:

# 1
Identifier0017266720001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier490003971
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRRMC - PALMETTO GBA

VIII. Authorized Official

Name: NICHOLAS J BARNA
Title or Position: CEO
Credential: MD
Phone: 570-288-1974