Provider Demographics
NPI:1376511857
Name:EASTERN PENNSYLVANIA ENDOSCOPY CENTER, INC.
Entity Type:Organization
Organization Name:EASTERN PENNSYLVANIA ENDOSCOPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-289-2172
Mailing Address - Street 1:1501 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2309
Mailing Address - Country:US
Mailing Address - Phone:610-289-2172
Mailing Address - Fax:
Practice Address - Street 1:1501 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2309
Practice Address - Country:US
Practice Address - Phone:610-289-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15211501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007770160004Medicaid
PA1604OtherHIGHMARK FACILITY
PA216599OtherHEALTH ASSURANCE FACILITY
PA0415476OtherCIGNA
PA20013921Medicaid
PA257972OtherHEALTH ASSURANCE ANESTHES
PA7438374OtherAETNA
PA0001593000OtherINDEPENDENCE BC FACILITY
PA390841OtherCAPITAL BLUE CROSS
PA20013921Medicaid
PA=========OtherTAX ID
PA257972OtherHEALTH ASSURANCE ANESTHES