Provider Demographics
NPI:1326298423
Name:GREATER ERIE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GREATER ERIE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KISIEL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CNOR
Authorized Official - Phone:814-790-5636
Mailing Address - Street 1:2374 VILLAGE COMMON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7201
Mailing Address - Country:US
Mailing Address - Phone:814-790-5636
Mailing Address - Fax:814-790-5654
Practice Address - Street 1:2374 VILLAGE COMMON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-790-5636
Practice Address - Fax:814-790-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21811501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical