Provider Demographics
NPI:1790786218
Name:FORT WASHINGTON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FORT WASHINGTON SURGERY CENTER, LLC
Other - Org Name:THE SURGERY CENTER AT FORT WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-628-4300
Mailing Address - Street 1:467 PENNSYLVANIA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3420
Mailing Address - Country:US
Mailing Address - Phone:215-628-4300
Mailing Address - Fax:215-628-2704
Practice Address - Street 1:467 PENNSYLVANIA AVE STE 108
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3420
Practice Address - Country:US
Practice Address - Phone:215-628-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA55551500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1790786218Medicare NSC