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General NPI Number Information
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NPI Number | 1083877724
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Entity Type | Organization
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Legal Business Name | CONYNGHAM VALLEY SURGICENTER PC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 8 BROOKHILL SQ S
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City | SUGARLOAF
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State | PA
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Zip | 18249-1010
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Country | US
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Telephone | 570-788-2733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | SYBERTSVILLE
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State | PA
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Zip | 18251-0322
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Country | US
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Telephone | 570-788-2733
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DANIEL L SON
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Credential | MD
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Telephone | 570-788-2733
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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 | MD038350L
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License Number State | PA
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