Provider Demographics
NPI:1265435176
Name:POCONO AMBULATORY SURGERY CENTER LTD
Entity type:Organization
Organization Name:POCONO AMBULATORY SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-421-4978
Mailing Address - Street 1:1 VETERANS PL
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2418
Mailing Address - Country:US
Mailing Address - Phone:570-421-4978
Mailing Address - Fax:570-424-7312
Practice Address - Street 1:1 VETERANS PL
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2418
Practice Address - Country:US
Practice Address - Phone:570-421-4978
Practice Address - Fax:570-424-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16821500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075186OtherFIRST PRIORITY HEALTH PRO
PA2175169OtherUNITED HEALTHCARE PROVIDE
PAA1985647OtherOXFORD PROVIDER NUMBER
PA0078006230002Medicaid
PA22777OtherGEISINGER PROVIDER NUMBER
PA78251OtherMED PLUS PROVIDER NUMBER
PA303901OtherBLUE CROSS PROVIDER NUMBE
PA8496212OtherAETNA PROVIDER NUMBER
PA303901Medicare PIN