Provider Demographics
NPI:1821093204
Name:LAUREL LASER & SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:LAUREL LASER & SURGERY CENTER, L.P.
Other - Org Name:
Other - Org Type:
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 1:52 WATERFORD PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2518
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:2005-06-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11351500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
138792OtherHEALTH AMERICA/ASSURANCE
2326303OtherAETNA
1343OtherHIGHMARK BLUE CROSS BLUE
PA216106OtherUPMC
001=========OtherTRICARE