Provider Demographics
NPI:1063685980
Name:SUSQUEHANNA ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:SUSQUEHANNA ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEUHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-368-5561
Mailing Address - Street 1:10 CHOATE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754
Mailing Address - Country:US
Mailing Address - Phone:570-368-5581
Mailing Address - Fax:570-368-5564
Practice Address - Street 1:10 CHOATE CIRCLE
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754
Practice Address - Country:US
Practice Address - Phone:570-368-5581
Practice Address - Fax:570-368-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00673224OtherRAILROAD MEDICARE