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General NPI Number Information
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NPI Number | 1205859550
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Entity Type | Organization
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Legal Business Name | COMMUNITY SURGERY & LASER CENTER, LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2 FARM COLONY DRIVE
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City | WARREN
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State | PA
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Zip | 16365-5206
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Country | US
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Telephone | 814-726-2303
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Fax | 404-305-3199
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Provider Business Mailing Address
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Address Line | 2 FARM COLONY DRIVE
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City | WARREN
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State | PA
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Zip | 16365-5206
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Country | US
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Telephone | 814-726-2303
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Fax | 814-726-7459
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Authorized Official
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Title or Position | CHIEF REVENUE CYCLE OFFICER
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Name | CANDICE B DAVIS
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Credential |
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Telephone | 916-990-7590
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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 | MD052930L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 20821501
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License Number State | PA
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