MEDICARE: WYOMISSING SURGICAL SERVICES INC.

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	16691501	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2072	OTHER	PA	INDEPENDENCE BLUE CROSS
2	390850	OTHER	PA	CAPITAL BLUE CROSS
3	1869	OTHER	PA	HIGHMARK BLUE SHIELD
4	104918000	OTHER	PA	FEDERAL WORKER'S COMP
5	231648	OTHER	PA	HEALTHAMERICA

General Provider Information

NPI Number	:	1568469328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMISSING SURGICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	1235 PENN AVE
Second Line	:	SUITE 100
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2100
Country	:	US
Telephone Number	:	610-373-3715
Fax Number	:	610-373-3164

Provider Business Practice Location Address
First Line	:	1235 PENN AVE
Second Line	:	SUITE 100
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2100
Country	:	US
Telephone Number	:	610-373-3715
Fax Number	:	610-373-3164

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JASON THOMAS BUNDY
Credential	:	M.D.
Telephone Number	:	610-373-3715

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/27/2016

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Directions to “WYOMISSING SURGICAL SERVICES INC. ” Practice Location

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