Provider Demographics
NPI:1164419842
Name:MONTGOMERY SURGERY CENTER LLC.
Entity Type:Organization
Organization Name:MONTGOMERY SURGERY CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-412-9115
Mailing Address - Street 1:1000 N BROAD ST
Mailing Address - Street 2:SUITE2
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1138
Mailing Address - Country:US
Mailing Address - Phone:215-412-9115
Mailing Address - Fax:215-412-0488
Practice Address - Street 1:1000 N BROAD ST
Practice Address - Street 2:SUITE2
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1138
Practice Address - Country:US
Practice Address - Phone:215-412-9115
Practice Address - Fax:215-412-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15231501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054164Medicare ID - Type Unspecified