Provider Demographics
NPI:1164458824
Name:BLAIR ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:BLAIR ENDOSCOPY CENTER, LLC
Other - Org Name:ALLEGHENY REGIONAL ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRZANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-946-5469
Mailing Address - Street 1:810 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6342
Mailing Address - Country:US
Mailing Address - Phone:814-946-8980
Mailing Address - Fax:814-946-4970
Practice Address - Street 1:810 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6342
Practice Address - Country:US
Practice Address - Phone:814-946-8980
Practice Address - Fax:814-946-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1863261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015543100001Medicaid
PA099333Medicare PIN
PAP00292022OtherRAILROAD MEDICARE