Provider Demographics
NPI:1861668899
Name:MYERS AMBUCARE SURGERY, LTD.
Entity Type:Organization
Organization Name:MYERS AMBUCARE SURGERY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-215-7912
Mailing Address - Street 1:6211 CIDER PRESS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4722
Mailing Address - Country:US
Mailing Address - Phone:717-215-7912
Mailing Address - Fax:
Practice Address - Street 1:6211 CIDER PRESS RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-4722
Practice Address - Country:US
Practice Address - Phone:717-215-7912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04583-L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022349410001Medicaid
804550HCXMedicare PIN
F43803Medicare UPIN
PA1022349410001Medicaid