Healthcare Provider Details

I. General information

NPI: 1780919043
Provider Name (Legal Business Name): SURGERY CENTER OF EDGEWOOD PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E LAUREL AVE
NEW CASTLE PA
16101-2354
US

IV. Provider business mailing address

239 EDGEWOOD DRIVE EXT
TRANSFER PA
16154-1817
US

V. Phone/Fax

Practice location:
  • Phone: 724-656-9181
  • Fax: 724-656-1340
Mailing address:
  • Phone: 724-646-0400
  • Fax: 724-646-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL TORN
Title or Position: CEO
Credential:
Phone: 724-646-0400