Provider Demographics
NPI:1205925278
Name:LUDWICK LASER & SURGERY CENTER, LLC
Entity type:Organization
Organization Name:LUDWICK LASER & SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LUDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-264-6560
Mailing Address - Street 1:825 5TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4213
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-264-6522
Practice Address - Street 1:825 5TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4213
Practice Address - Country:US
Practice Address - Phone:717-262-9700
Practice Address - Fax:717-264-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3332132261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1927OtherHIGHMARK BLUE SHIELD
PA390886OtherCAPITAL BLUE CROSS
PAP00424256OtherRAILROAD MEDICARE
PA1020010550001Medicaid
PAP00424256OtherRAILROAD MEDICARE