Provider Demographics
NPI:1649270075
Name:NORTHEAST REGIONAL SURGERY CENTER LLC
Entity type:Organization
Organization Name:NORTHEAST REGIONAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTASANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-970-1173
Mailing Address - Street 1:11 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1146
Mailing Address - Country:US
Mailing Address - Phone:570-970-1030
Mailing Address - Fax:570-270-0577
Practice Address - Street 1:11 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1146
Practice Address - Country:US
Practice Address - Phone:570-970-1030
Practice Address - Fax:570-270-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008875000001Medicaid
PA3346749OtherAETNA PROVIDER NUMBER
PA125451600OtherDEPT OF LABOR PROVIDER NU
PA398835OtherHIGH MARK
PA1008875000001Medicaid
PA075544OtherBLUE CROSS & WMC CHARGE M
PA3346749OtherAETNA PROVIDER NUMBER
PA000000148664Other3 RIVERS/MED PLUS PROVIDE
PA075544Medicare ID - Type UnspecifiedPROVIDER NUMBER