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General NPI Number Information
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NPI Number | 1174525661
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Entity Type | Organization
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Legal Business Name | HANOVER SURGICENTER, L.L.C.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 250 FAME AVE SUITE 130
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-633-1600
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Fax | 717-633-6556
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Provider Business Mailing Address
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Address Line | 250 FAME AVE SUIE 130
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-633-1600
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Fax | 717-633-6556
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DENISE A FAKE
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Credential | R.N.
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Telephone | 717-637-1600
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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 | 01681500
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License Number State | PA
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