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General NPI Number Information
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NPI Number | 1568469328
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Entity Type | Organization
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Legal Business Name | WYOMISSING SURGICAL SERVICES INC.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 1235 PENN AVE SUITE 100
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City | WYOMISSING
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State | PA
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Zip | 19610-2100
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Country | US
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Telephone | 610-373-3715
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Fax | 610-373-3164
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Provider Business Mailing Address
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Address Line | 1235 PENN AVE SUITE 100
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City | WYOMISSING
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State | PA
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Zip | 19610-2100
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Country | US
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Telephone | 610-373-3715
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Fax | 610-373-3164
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JASON THOMAS BUNDY
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Credential | M.D.
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Telephone | 610-373-3715
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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 | 16691501
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License Number State | PA
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