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General NPI Number Information
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NPI Number | 1689860124
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Entity Type | Organization
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Legal Business Name | PINE GROVE AMBULATORY SURGICAL
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 10 TIMBERVIEW LANE
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City | RUSSELL
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State | PA
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Zip | 16345
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Country | US
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Telephone | 814-757-5819
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Fax | 814-757-5829
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Provider Business Mailing Address
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Address Line | 10 TIMBERVIEW LANE
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City | RUSSELL
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State | PA
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Zip | 16345
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Country | US
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Telephone | 814-757-5819
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Fax | 814-757-5829
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. EMILEE S LANGER
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Credential | MPH
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Telephone | 814-688-0426
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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 |
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License Number State |
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