Provider Demographics
NPI:1821098443
Name:HAZLETON AMBULATORY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:HAZLETON AMBULATORY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-288-1974
Mailing Address - Street 1:1062 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1444
Mailing Address - Country:US
Mailing Address - Phone:570-459-5102
Mailing Address - Fax:570-459-9923
Practice Address - Street 1:1062 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1444
Practice Address - Country:US
Practice Address - Phone:570-459-5102
Practice Address - Fax:570-459-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017266720001Medicaid
PA490003971OtherRRMC - PALMETTO GBA
PA020055Medicare ID - Type Unspecified
PA0017266720001Medicaid