MEDICARE: STADIUM CAMPUS 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	11381500	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	:	1679658710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STADIUM CAMPUS AMBULATORY SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	3340 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5802
Country	:	US
Telephone Number	:	215-463-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5802
Country	:	US
Telephone Number	:	215-463-1900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH BILSON
Credential	:
Telephone Number	:	215-440-3152

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1639797574 — NIKIA MOODY PHARM. D
Practice Location Address:

3300 S BROAD ST
PHILADELPHIA, PA
19145-5802

Practice Phone: 215-463-0891
Practice Fax: 215-463-0895

1760086334 — DR. ENRICO PORCHIA PHARMD
Practice Location Address:

3300 S BROAD ST
PHILADELPHIA, PA
19145-5802

Practice Phone: 215-463-0891
Practice Fax: 215-463-0589

1255926432 — DR. TIDDY MAUTI PHARMD
Practice Location Address:

3300 S BROAD ST
PHILADELPHIA, PA
19145-5802

Practice Phone: 215-463-0891
Practice Fax:

1861697393 — DR. JOSEPH F ROBERTS DDS
Practice Location Address:

1804 RITTENHOUSE SQ
PHILADELPHIA, PA
19103-5802

Practice Phone: 215-735-9000
Practice Fax: 215-735-9125

1528263050 — DR. KATHRYN AMES DMD
Practice Location Address:

1804 RITTENHOUSE SQ
PHILADELPHIA, PA
19103-5802

Practice Phone: 215-735-9000
Practice Fax: 215-735-9125

1407224132 — SHRUTI TEWARI DMD
Practice Location Address:

1804 RITTENHOUSE SQ
PHILADELPHIA, PA
19103-5802

Practice Phone: 215-735-9000
Practice Fax:

Directions to “STADIUM CAMPUS AMBULATORY SURGICAL CENTER, 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.