Healthcare Provider Details

I. General information

NPI: 1346269784
Provider Name (Legal Business Name): SCHUYLKILL ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 TUNNEL RD SUITE 103
POTTSVILLE PA
17901-3875
US

IV. Provider business mailing address

48 TUNNEL RD SUITE 103
POTTSVILLE PA
17901-3875
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-6520
  • Fax:
Mailing address:
  • Phone: 570-622-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number17381501
License Number StatePA

VIII. Authorized Official

Name: MR. CHRISTOPHER A HOLDEN
Title or Position: PRESIDENT OF THE GENERAL PARTNER
Credential:
Phone: 615-665-1283