1730286097 NPI number — PLYMOUTH MEETING AMBULATORY SURGICAL CENTER LLC

Table of content: (NPI 1730286097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730286097 NPI number — PLYMOUTH MEETING AMBULATORY SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLYMOUTH MEETING AMBULATORY SURGICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLS EYE SURGERY CENTER OF PLYMOUTH MEETING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730286097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 W RIDGE PIKE
Provider Second Line Business Mailing Address:
BUILDING B
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-1180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-834-9700
Provider Business Mailing Address Fax Number:
610-834-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 W RIDGE PIKE
Provider Second Line Business Practice Location Address:
BUILDING B
Provider Business Practice Location Address City Name:
CONSHOHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428-1180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-834-9700
Provider Business Practice Location Address Fax Number:
610-834-9992
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRZESINSKI
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ADMINISTRATOR DIRECTOR OF NURSING
Authorized Official Telephone Number:
610-834-9700

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  07451500 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001639951003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001379000 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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