Provider Demographics
NPI:1245233410
Name:SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALTY CENTER OF NORTHEASTERN PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD # L&C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:190 WELLES ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4968
Practice Address - Country:US
Practice Address - Phone:570-331-7615
Practice Address - Fax:570-331-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA148601261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814135OtherFIRST PRIORITY HEALTH PRO
PA127866OtherMED PLUS/3 RIVERS PROVIDE
PA2139542OtherUNITED HEALTHCARE
PA991073OtherBLUE CROSS PROVIDER #
PA077861OtherAMERIHEALTH PROVIDER #
PA0198OtherFREEDOM BLUE
PA49005260OtherMEDICARE RAILROAD
PAA2738987OtherOXFORD PROVIDER #
PA68929OtherGEISINGER PROVIDER #
PAIY0345OtherHEALTH NET PROVIDER #
PA0018825790001Medicaid
PA2670019OtherAETNA PROVIDER NUMBER
PAA2738987OtherOXFORD PROVIDER #
PW=========OtherALL OTHER INSURANCE CO #
PA2139542OtherUNITED HEALTHCARE