Healthcare Provider Details

I. General information

NPI: 1437148681
Provider Name (Legal Business Name): REGIONAL AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 BUCKTAIL RD
ST MARYS PA
15857-3212
US

IV. Provider business mailing address

1376 BUCKTAIL RD
ST MARYS PA
15857-3212
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-6565
  • Fax: 814-781-1985
Mailing address:
  • Phone: 814-781-6565
  • Fax: 814-781-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number15531501
License Number StatePA

VIII. Authorized Official

Name: DR. K.C. JOSEPH
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 814-781-6565