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General NPI Number Information
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NPI Number | 1679658710
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Entity Type | Organization
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Legal Business Name | STADIUM CAMPUS AMBULATORY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3340 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-5802
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Country | US
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Telephone | 215-463-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-5802
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Country | US
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Telephone | 215-463-1900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH BILSON
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Credential |
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Telephone | 215-440-3152
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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 | 11381500
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License Number State | PA
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