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1245233410

NPI Code Detail

MEDICARE: SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC

MEDICARE: SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, 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	148601	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	49005260	OTHER	PA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	814135	OTHER	PA	FIRST PRIORITY HEALTH PRO
2	127866	OTHER	PA	MED PLUS/3 RIVERS PROVIDE
3	2139542	OTHER	PA	UNITED HEALTHCARE
4	991073	OTHER	PA	BLUE CROSS PROVIDER #
5	077861	OTHER	PA	AMERIHEALTH PROVIDER #
6	0198	OTHER	PA	FREEDOM BLUE
8	A2738987	OTHER	PA	OXFORD PROVIDER #
9	68929	OTHER	PA	GEISINGER PROVIDER #
10	IY0345	OTHER	PA	HEALTH NET PROVIDER #
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	2670019	OTHER	PA	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1245233410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC

Provider Business Mailing Address
First Line	:	1A BURTON HILLS BLVD # L&C
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6187
Country	:	US
Telephone Number	:	615-240-3820
Fax Number	:	615-234-1720

Provider Business Practice Location Address
First Line	:	190 WELLES ST
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4968
Country	:	US
Telephone Number	:	570-331-7615
Fax Number	:	570-331-7614

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY SNODGRASS
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/14/2022

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Practice Fax:

1104804889 — RADIATION MEDICINE SPECIALISTS OF NORTHEAST PENNSYLVANIA P C
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1720066392 — WYOMING VALLEY PET ASSOCIATES
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1235118522 — SLEEP DISORDERS CENTER OF WYOMING VALLEY, LLC
Practice Location Address:

190 WELLES ST , SUITE 116
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1013954007 — ANDREW T TURRISI III MD
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1023050663 — DR. LOUIS R. SIEMINSKI PH.D.
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Directions to “SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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