Provider Demographics
NPI:1467774596
Name:SAUCON CREEK PATIENT CARE LLC
Entity Type:Organization
Organization Name:SAUCON CREEK PATIENT CARE LLC
Other - Org Name:SAUCON VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-625-9090
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-0129
Mailing Address - Country:US
Mailing Address - Phone:610-625-2010
Mailing Address - Fax:610-625-2314
Practice Address - Street 1:4801 SAUCON CREEK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-9065
Practice Address - Country:US
Practice Address - Phone:610-625-9090
Practice Address - Fax:610-625-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008484-L261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG43806Medicare UPIN
PAOS008986LOtherPA LICENSE
PA11585351OtherCAQH#