Provider Demographics
NPI:1922025006
Name:SURGERY CENTER OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-853-7700
Mailing Address - Street 1:2010 W CHESTER PIKE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2700
Mailing Address - Country:US
Mailing Address - Phone:610-853-7700
Mailing Address - Fax:610-853-7755
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:SUITE 212
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2700
Practice Address - Country:US
Practice Address - Phone:610-853-7700
Practice Address - Fax:610-853-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10271500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001618000OtherKEYSTONE HEALTH PLAN EAST
PA3052119OtherAETNA
PA1618OtherINDEPENDENCE BLUE CROSS
PA30005351OtherKEYSTONE MERCY HEALTH PLA
PA0019414000001Medicaid
PA30005351OtherKEYSTONE MERCY HEALTH PLA