Healthcare Provider Details

I. General information

NPI: 1649270075
Provider Name (Legal Business Name): NORTHEAST REGIONAL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

IV. Provider business mailing address

11 GALLAGHER DR
PLAINS PA
18705-1146
US

V. Phone/Fax

Practice location:
  • Phone: 570-970-1030
  • Fax: 570-270-0577
Mailing address:
  • Phone: 570-970-1030
  • Fax: 570-270-0577

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: ROBIN SANTASANIA
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 570-970-1173