Provider Demographics
NPI:1235788878
Name:INTEGRATED SURGICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:INTEGRATED SURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-237-2103
Mailing Address - Street 1:215 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2883
Mailing Address - Country:US
Mailing Address - Phone:215-237-2103
Mailing Address - Fax:
Practice Address - Street 1:WEST RIDGE BUSINESS CAMPUS
Practice Address - Street 2:1001 JAMES DRIVE
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533
Practice Address - Country:US
Practice Address - Phone:215-237-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical