Healthcare Provider Details

I. General information

NPI: 1740823848
Provider Name (Legal Business Name): KING OF PRUSSIA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 PULASKI DR STE 140
KING OF PRUSSIA PA
19406-2802
US

IV. Provider business mailing address

950 PULASKI DR STE 140
KING OF PRUSSIA PA
19406-2802
US

V. Phone/Fax

Practice location:
  • Phone: 215-521-3030
  • Fax:
Mailing address:
  • Phone: 215-521-3030
  • 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 Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW O'MALLEY
Title or Position: PRESIDENT, BOARD OF MANAGERS
Credential:
Phone: 610-798-6054