Provider Demographics
NPI:1902848260
Name:COMMUNITY AMBULATORY CARE CENTER (CACC), LP
Entity Type:Organization
Organization Name:COMMUNITY AMBULATORY CARE CENTER (CACC), LP
Other - Org Name:FAIRGROUNDS SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CODIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-821-2015
Mailing Address - Street 1:400 N 17TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5052
Mailing Address - Country:US
Mailing Address - Phone:610-821-2020
Mailing Address - Fax:610-821-2016
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:STE 300
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5052
Practice Address - Country:US
Practice Address - Phone:610-821-2020
Practice Address - Fax:610-821-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06331500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391029Medicare ID - Type Unspecified