Provider Demographics
NPI:1518930866
Name:ENDOSCOPY CENTER OF PENNSYLVANIA INC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF PENNSYLVANIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:717-242-4556
Mailing Address - Street 1:310 ELECTRIC AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1369
Mailing Address - Country:US
Mailing Address - Phone:717-242-7136
Mailing Address - Fax:717-242-5254
Practice Address - Street 1:310 ELECTRIC AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1369
Practice Address - Country:US
Practice Address - Phone:717-242-7136
Practice Address - Fax:717-242-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016165450002Medicaid
PAEN 391059Medicare ID - Type Unspecified