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General NPI Number Information
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NPI Number | 1134114119
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Entity Type | Organization
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Legal Business Name | EVANGELICAL AMBULATORY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 210 JPM RD
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City | LEWISBURG
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State | PA
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Zip | 17837-9367
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Country | US
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Telephone | 570-524-6700
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Fax | 570-524-6710
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Provider Business Mailing Address
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Address Line | 210 JPM RD
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City | LEWISBURG
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State | PA
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Zip | 17837-9367
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Country | US
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Telephone | 570-524-6700
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Fax | 570-524-6710
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. WILLIAM J. MALONEY
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Credential |
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Telephone | 570-524-6700
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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 | 14631501
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License Number State | PA
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