Provider Demographics
NPI:1295901445
Name:CROSSROADS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CROSSROADS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIDCAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-569-9636
Mailing Address - Street 1:4150 BARRETT BOULEVARD
Mailing Address - Street 2:P. O. BOX 544
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-0001
Mailing Address - Country:US
Mailing Address - Phone:267-960-1409
Mailing Address - Fax:215-443-9622
Practice Address - Street 1:4150 BARRETT BOULEVARD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-0001
Practice Address - Country:US
Practice Address - Phone:267-960-1409
Practice Address - Fax:215-443-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical