Provider Demographics
NPI:1336170596
Name:THE UROLOGIC SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:THE UROLOGIC SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALTADONNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-397-4254
Mailing Address - Street 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:STE 1
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-397-4254
Mailing Address - Fax:717-735-8154
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:STE 1
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-397-4254
Practice Address - Fax:717-735-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016470990001Medicaid
PA1016470990001Medicaid