Provider Demographics
NPI:1851406821
Name:HAZLETON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HAZLETON SURGERY CENTER, LLC
Other - Org Name:HAZLETON SURGERY CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER, MEDICARE AUTHORIZED OFFICI
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:50 MOISEY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9297
Mailing Address - Country:US
Mailing Address - Phone:570-501-6500
Mailing Address - Fax:
Practice Address - Street 1:50 MOISEY DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9297
Practice Address - Country:US
Practice Address - Phone:570-501-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11848Medicare PIN
PA111848Medicare PIN