Provider Demographics
NPI:1467442657
Name:HOLY REDEEMER AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HOLY REDEEMER AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-856-1114
Mailing Address - Street 1:821 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8365
Mailing Address - Country:US
Mailing Address - Phone:215-214-0500
Mailing Address - Fax:215-214-0566
Practice Address - Street 1:821 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8365
Practice Address - Country:US
Practice Address - Phone:215-214-0500
Practice Address - Fax:215-214-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11251500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical