Provider Demographics
NPI:1922071315
Name:SENECA PA ASC LLC
Entity Type:Organization
Organization Name:SENECA PA ASC LLC
Other - Org Name:THE SURGERY AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:3744 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3318
Mailing Address - Country:US
Mailing Address - Phone:814-677-6700
Mailing Address - Fax:814-677-6776
Practice Address - Street 1:3744 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3318
Practice Address - Country:US
Practice Address - Phone:814-677-6700
Practice Address - Fax:814-677-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11721500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01832782Medicaid
OH2238171Medicaid
PA01832782Medicaid
PA=========OtherTRICARE
PA39C0001094Medicare Oscar/Certification
PA043555Medicare PIN