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General NPI Number Information
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NPI Number | 1821093204
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Entity Type | Organization
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Legal Business Name | LAUREL LASER & SURGERY CENTER, L.P.
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 52 WATERFORD PIKE
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City | BROOKVILLE
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State | PA
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Zip | 15825-2518
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Country | US
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Telephone | 814-849-0898
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Fax | 814-849-2890
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Provider Business Mailing Address
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Address Line | 52 WATERFORD PIKE
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City | BROOKVILLE
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State | PA
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Zip | 15825-2518
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Country | US
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Telephone | 814-849-0898
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Fax | 814-849-2890
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Authorized Official
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Title or Position | CLINICAL DIRECTOR / ADMINISTRATOR
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Name | WHITNEY N SUTLEY
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Credential | RN
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Telephone | 814-849-6561
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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 | 11351500
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License Number State | PA
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