Provider Demographics
NPI:1568625143
Name:MIDSTATE INSTITUTE OF SURGERY LLC
Entity Type:Organization
Organization Name:MIDSTATE INSTITUTE OF SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-718-7707
Mailing Address - Street 1:601 E SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3456
Mailing Address - Country:US
Mailing Address - Phone:717-691-7100
Mailing Address - Fax:717-691-6855
Practice Address - Street 1:1796 3RD AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1913
Practice Address - Country:US
Practice Address - Phone:717-718-7707
Practice Address - Fax:717-718-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679694723OtherINDIVIDUAL NPI
1679694723OtherINDIVIDUAL NPI