Healthcare Provider Details

I. General information

NPI: 1851406821
Provider Name (Legal Business Name): HAZLETON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOISEY DRIVE SUITE 100
HAZLETON PA
18202-9297
US

IV. Provider business mailing address

50 MOISEY DRIVE SUITE 100
HAZLETON PA
18202-9297
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6500
  • Fax:
Mailing address:
  • Phone: 570-501-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER, MEDICARE AUTHORIZED OFFICI
Credential:
Phone: 203-609-1168