MEDICARE: HAZLETON SURGERY 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	261QM1300X	Multi-Specialty Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1851406821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZLETON SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	50 MOISEY DRIVE
Second Line	:	SUITE 100
City	:	HAZLETON
State	:	PA
Zip	:	18202-9297
Country	:	US
Telephone Number	:	570-501-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MOISEY DRIVE
Second Line	:	SUITE 100
City	:	HAZLETON
State	:	PA
Zip	:	18202-9297
Country	:	US
Telephone Number	:	570-501-6500
Fax Number	:

Authorized Official
Title or Position	:	OFFICER, MEDICARE AUTHORIZED OFFICI
Name	:	JONATHAN BAILEY
Credential	:
Telephone Number	:	203-609-1168

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/09/2024

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