Provider Demographics
NPI:1376906354
Name:PREMIER AT EXTON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PREMIER AT EXTON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-609-1168
Mailing Address - Street 1:491 JOHN YOUNG WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2567
Mailing Address - Country:US
Mailing Address - Phone:484-872-8408
Mailing Address - Fax:
Practice Address - Street 1:491 JOHN YOUNG WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:484-872-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical