Provider Demographics
NPI:1225293087
Name:CENTENNIAL SURGUNIT, LLC
Entity Type:Organization
Organization Name:CENTENNIAL SURGUNIT, LLC
Other - Org Name:CENTENNIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:T
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPC, RMC
Authorized Official - Phone:856-874-0790
Mailing Address - Street 1:502 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9544
Mailing Address - Country:US
Mailing Address - Phone:856-874-0790
Mailing Address - Fax:856-741-1182
Practice Address - Street 1:502 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9544
Practice Address - Country:US
Practice Address - Phone:856-874-0790
Practice Address - Fax:856-741-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22835261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8084009Medicaid
NJ8084009Medicaid