MEDICARE: WILKES BARRE ASC., LP

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	261Q00000X	Clinic/Center	12831500	PA
2	261QA1903X	Ambulatory Surgical Clinic/Center	12831500	PA
3	261QM1300X	Multi-Specialty Clinic/Center	12831500	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	:	1962405894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKES BARRE ASC., LP

Provider Business Mailing Address
First Line	:	545 N RIVER ST
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-9010
Fax Number	:	570-270-6488

Provider Business Practice Location Address
First Line	:	545 N RIVER ST
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	570-822-9010
Fax Number	:	570-270-6488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AKRAM ZALATIMO
Credential	:	M.D.
Telephone Number	:	570-822-9010

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/19/2008

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Directions to “WILKES BARRE ASC., LP ” Practice Location

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