Provider Demographics
NPI:1326097536
Name:HARRISBURG ENDOSCOPY & SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:HARRISBURG ENDOSCOPY & SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:717-545-8525
Mailing Address - Street 1:4760 UNION DEPOSIT RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3729
Mailing Address - Country:US
Mailing Address - Phone:717-545-8525
Mailing Address - Fax:717-545-7388
Practice Address - Street 1:4760 UNION DEPOSIT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3729
Practice Address - Country:US
Practice Address - Phone:717-545-8525
Practice Address - Fax:717-545-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11431500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001847195002Medicaid
PA11431500OtherSTATE ASF LICENSE #
PA11431500OtherSTATE ASF LICENSE #