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General NPI Number Information
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NPI Number | 1194027920
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Entity Type | Organization
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Legal Business Name | GRANT SURGICENTER LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2000 GRANT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-7287
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Country | US
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Telephone | 215-992-6000
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Fax | 215-992-6001
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Provider Business Mailing Address
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Address Line | 2000 GRANT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-7287
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Country | US
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Telephone | 215-992-6000
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Fax | 215-992-6001
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Authorized Official
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Title or Position | OFFICER/AO
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Name | JONATHAN BAILEY
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Credential | MD
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Telephone | 203-609-1168
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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 |
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License Number State | PA
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