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General NPI Number Information
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NPI Number | 1326298423
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Entity Type | Organization
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Legal Business Name | GREATER ERIE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2374 VILLAGE COMMON DR SUITE 200
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City | ERIE
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State | PA
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Zip | 16506-7201
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Country | US
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Telephone | 814-790-5636
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Fax | 814-790-5654
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Provider Business Mailing Address
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Address Line | 2374 VILLAGE COMMON DR SUITE 200
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City | ERIE
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State | PA
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Zip | 16506-7201
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Country | US
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Telephone | 814-790-5636
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Fax | 814-790-5654
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Authorized Official
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Title or Position | ADMINISTRATOR/DIRECTOR OF NURSING
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Name | MRS. KRISTIE M KISIEL
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Credential | BSN, RN, CNOR
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Telephone | 814-790-5636
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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 | 21811501
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License Number State | PA
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