Provider Demographics
NPI:1699813774
Name:LAUREL LASER & SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:LAUREL LASER & SURGERY CENTER, L.P.
Other - Org Name:LAUREL LASER & SURGERY CENTER-ALTOONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-849-0898
Mailing Address - Street 1:52 WATERFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-2518
Mailing Address - Country:US
Mailing Address - Phone:814-849-0898
Mailing Address - Fax:814-849-2890
Practice Address - Street 1:176 VISION DRIVE
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-849-0898
Practice Address - Fax:814-849-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA737168OtherHEALTH AMERICA
PA1437OtherBLUE CROSS
PA0018054350006Medicaid
PA261606OtherUPMC
PAP00478269OtherRAILROAD MEDICARE
PA261606OtherUPMC
PA115217Medicare Oscar/Certification