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General NPI Number Information
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NPI Number | 1861601098
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Entity Type | Organization
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Legal Business Name | SUNBURY HOSPITAL CORPORATION
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 350 N 11TH ST
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City | SUNBURY
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State | PA
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Zip | 17801-1611
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Country | US
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Telephone | 570-286-3333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504236
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 570-286-3333
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Fax |
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Authorized Official
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Title or Position | PRESIDENT GROUP OPERATIONS
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Name | MR. GARY NEWSOME
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Credential |
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Telephone | 615-465-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 450302
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 450302
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License Number State | PA
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