Provider Demographics
NPI:1184699233
Name:LAWRENCE COUNTY SURGERY CENTER, L.L.C.
Entity type:Organization
Organization Name:LAWRENCE COUNTY SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:REDOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-656-9181
Mailing Address - Street 1:2 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2354
Mailing Address - Country:US
Mailing Address - Phone:724-656-9181
Mailing Address - Fax:724-656-1340
Practice Address - Street 1:2 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2354
Practice Address - Country:US
Practice Address - Phone:724-656-9181
Practice Address - Fax:724-656-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2102OtherBLUE SHIELD
PA000000151037OtherTHREE RIVERS
PA1010666450001Medicaid
PA241729OtherHEALTH AMERICA/ADVANTRA
PAP00083129OtherRAILROAD MEDICARE
PA1540559OtherGATEWAY
PA076334Medicare ID - Type Unspecified