Provider Demographics
NPI:1841759040
Name:BEAVER VALLEY AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BEAVER VALLEY AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLEBODNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-346-2400
Mailing Address - Street 1:766 E PITTSBURGH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2678
Mailing Address - Country:US
Mailing Address - Phone:412-346-2400
Mailing Address - Fax:
Practice Address - Street 1:79 WAGNER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2489
Practice Address - Country:US
Practice Address - Phone:724-624-9901
Practice Address - Fax:724-624-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical