Healthcare Provider Details

I. General information

NPI: 1306958103
Provider Name (Legal Business Name): NEI AMBULATORY SURGERY CENTER INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MIFFLIN AVE
SCRANTON PA
18503
US

IV. Provider business mailing address

204 MIFFLIN AVE
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax:
Mailing address:
  • Phone: 570-342-3145
  • Fax: 570-344-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier303535
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 2
Identifier069868
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY HEALTH
# 3
Identifier530966
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 4
Identifier080011512060001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JEROME W JORDON
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 570-342-3145