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General NPI Number Information
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NPI Number | 1265435176
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Entity Type | Organization
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Legal Business Name | POCONO AMBULATORY SURGERY CENTER LTD
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1 VETERANS PL
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City | STROUDSBURG
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State | PA
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Zip | 18360-2418
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Country | US
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Telephone | 570-421-4978
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Fax | 570-424-7312
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Provider Business Mailing Address
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Address Line | 1 VETERANS PL
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City | STROUDSBURG
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State | PA
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Zip | 18360-2418
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Country | US
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Telephone | 570-421-4978
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Fax | 570-424-7312
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. JOSEPH B CONAHAN
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Credential | M.D.
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Telephone | 570-421-4978
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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 | 16821500
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License Number State | PA
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