Provider Demographics
NPI:1669647210
Name:SAINT VINCENT ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:SAINT VINCENT ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SABLYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9001
Mailing Address - Street 1:PO BOX 415357
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5357
Mailing Address - Country:US
Mailing Address - Phone:215-589-9000
Mailing Address - Fax:215-589-9030
Practice Address - Street 1:2501 W 12TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:215-589-9000
Practice Address - Fax:215-589-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
82192OtherAAAHC ACCREDITATION
PA100246794 0001Medicaid
PA100246794 0001Medicaid