Provider Demographics
NPI:1669465209
Name:FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY LP
Entity Type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY LP
Other - Org Name:HUNTINGDON VALLEY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP AND CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-1706
Mailing Address - Street 1:14000 N PORTLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4003
Mailing Address - Country:US
Mailing Address - Phone:405-608-1700
Mailing Address - Fax:405-608-1800
Practice Address - Street 1:1800 BYBERRY ROAD
Practice Address - Street 2:BUILDING 10
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-914-4600
Practice Address - Fax:215-947-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17131501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001397000OtherID # FOR BLUE CROSS
PA1008872050001Medicaid
PA0001397000OtherID # FOR BLUE CROSS