Provider Demographics
NPI:1376649590
Name:DICE SURGICAL AND HOME HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:DICE SURGICAL AND HOME HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-322-0656
Mailing Address - Street 1:1300 SHERIDAN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3760
Mailing Address - Country:US
Mailing Address - Phone:570-322-0656
Mailing Address - Fax:570-322-0659
Practice Address - Street 1:1300 SHERIDAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3760
Practice Address - Country:US
Practice Address - Phone:570-322-0656
Practice Address - Fax:570-322-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000000476332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012289830003Medicaid
PA0012289830003Medicaid