Provider Demographics
NPI:1457538639
Name:SURGICENTER OF VINELAND, LLC
Entity Type:Organization
Organization Name:SURGICENTER OF VINELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ASC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNIFICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-216-1700
Mailing Address - Street 1:251 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7802
Mailing Address - Country:US
Mailing Address - Phone:856-691-8188
Mailing Address - Fax:856-691-0421
Practice Address - Street 1:251 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7802
Practice Address - Country:US
Practice Address - Phone:856-691-8188
Practice Address - Fax:856-691-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00646845OtherRAILROAD MEDICARE
P00646845OtherRAILROAD MEDICARE
=========OtherTIN
130539Medicare PIN