MEDICARE: SUSQUEHANNA VALLEY SURGERY CENTER

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	11761500	PA

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

General Provider Information

NPI Number	:	1558363549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSQUEHANNA VALLEY SURGERY CENTER

Provider Business Mailing Address
First Line	:	4310 LONDONDERRY RD STE 1
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5302
Country	:	US
Telephone Number	:	717-657-7556
Fax Number	:	717-657-7558

Provider Business Practice Location Address
First Line	:	4310 LONDONDERRY ROAD
Second Line	:	SUITE #1
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5317
Country	:	US
Telephone Number	:	717-657-7556
Fax Number	:	717-657-7558

Authorized Official
Title or Position	:	CHAIRMAN OF BOARD
Name	:	ANDREW SHAPIRO
Credential	:	MD
Telephone Number	:	717-657-7556

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/26/2018

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