Provider Demographics
NPI:1093739492
Name:MINE HILL SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:MINE HILL SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN-TRANSITION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-989-5185
Mailing Address - Street 1:195 ROUTE 46
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-989-5185
Mailing Address - Fax:973-328-4097
Practice Address - Street 1:195 ROUTE 46
Practice Address - Street 2:SUITE 202
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-989-5185
Practice Address - Fax:973-328-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical