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1134114119

NPI Code Detail

MEDICARE: EVANGELICAL AMBULATORY SURGICAL CENTER, LLC

MEDICARE: EVANGELICAL AMBULATORY SURGICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	14631501	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	490005320	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	20025739	OTHER	PA	AMERIHEALTH PROVIDER NUMB
3	39C0001119	OTHER	PA	STERLING OPTION I
4	79197	OTHER	PA	GEISINGER HEALTH PLAN
5	0167726	OTHER	PA	DEPARTMENT OF LABOR PROV#
6	155458XX	OTHER	PA	PREFERRED CARE
7	151805	OTHER	PA	HEALTH AMERICA PROV#
8	390839	OTHER	PA	CAPITAL BLUE CROSS
9	1599	OTHER	PA	HIGHMARK BLUESHIELD

General Provider Information

NPI Number	:	1134114119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANGELICAL AMBULATORY SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	210 JPM RD
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9367
Country	:	US
Telephone Number	:	570-524-6700
Fax Number	:	570-524-6710

Provider Business Practice Location Address
First Line	:	210 JPM RD
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9367
Country	:	US
Telephone Number	:	570-524-6700
Fax Number	:	570-524-6710

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. WILLIAM J. MALONEY
Credential	:
Telephone Number	:	570-524-6700

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	04/22/2008

Similar Medicare Providers

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Practice Location Address:

210 JPM RD STE 300
LEWISBURG, PA
17837-9367

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1114996030 — MR. ROBERT S VEACH PA-C
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1386112514 — KAITLYN RENAE PALETTA PA-C
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17837-9367

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1558374124 — KEITH A ROUSE DPM
Practice Location Address:

210 JPM RD STE 300
LEWISBURG, PA
17837-9367

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1023012861 — DR. CHARLES L COLE JR. MD
Practice Location Address:

210 JPM RD STE 300
LEWISBURG, PA
17837-9367

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1093708372 — DR. ERNEST Y. NORMINGTON III M.D.
Practice Location Address:

135 WALTER DRIVE
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Directions to “EVANGELICAL AMBULATORY SURGICAL CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

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