Healthcare Provider Details

I. General information

NPI: 1003935354
Provider Name (Legal Business Name): MIFFLIN COUNTY COMMUNITY SURGICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 4TH ST
LEWISTOWN PA
17044-1316
US

IV. Provider business mailing address

27 SANDY LN STE 220
LEWISTOWN PA
17044-1320
US

V. Phone/Fax

Practice location:
  • Phone: 717-242-9565
  • Fax: 717-242-9510
Mailing address:
  • Phone: 717-242-4805
  • Fax: 717-242-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10611500-PII
License Number StatePA

VIII. Authorized Official

Name: ALAN D GORDON
Title or Position: PRESIDENT
Credential: MD
Phone: 717-242-2514