Provider Demographics
NPI:1427015999
Name:WEST SHORE SURGERY CENTER, LTD
Entity Type:Organization
Organization Name:WEST SHORE SURGERY CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:717-791-2506
Mailing Address - Street 1:2015 TECHNOLOGY PKWY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9497
Mailing Address - Country:US
Mailing Address - Phone:717-791-2506
Mailing Address - Fax:
Practice Address - Street 1:2015 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9497
Practice Address - Country:US
Practice Address - Phone:717-791-2506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12371501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01838884Medicaid
PA1603OtherHIGHMARK BLUE SHIELD
PA390830OtherCAPITAL BLUE CROSS
PA140655OtherUNITED HEALTHCARE
PA1519134OtherGATEWAY
PA390830OtherKEYSTONE SENIOR BLUE
PA140655OtherUNITED HEALTHCARE
PA626834OtherANTHEM
PA1275128OtherMEDPLUS
PA1519134OtherGATEWAY
PA1519134Medicare ID - Type UnspecifiedGATEWAY MEDICARE ASSURED
PA01838884Medicaid
PA140655OtherUNITED HEALTHCARE
PA1603OtherHIGHMARK BLUE SHIELD
PA390830OtherKEYSTONE SENIOR BLUE