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General NPI Number Information
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NPI Number | 1003935354
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Entity Type | Organization
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Legal Business Name | MIFFLIN COUNTY COMMUNITY SURGICAL CENTER PC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 311 4TH ST
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City | LEWISTOWN
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State | PA
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Zip | 17044-1316
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Country | US
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Telephone | 717-242-9565
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Fax | 717-242-9510
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Provider Business Mailing Address
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Address Line | 27 SANDY LN STE 220
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City | LEWISTOWN
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State | PA
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Zip | 17044-1320
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Country | US
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Telephone | 717-242-4805
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Fax | 717-242-5900
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAN D GORDON
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Credential | MD
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Telephone | 717-242-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 10611500-PII
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License Number State | PA
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