Provider Demographics
NPI:1740448711
Name:TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-684-6047
Mailing Address - Street 1:4979 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6222
Mailing Address - Country:US
Mailing Address - Phone:267-684-6047
Mailing Address - Fax:267-684-6056
Practice Address - Street 1:4979 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6222
Practice Address - Country:US
Practice Address - Phone:267-684-6047
Practice Address - Fax:267-684-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22411501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherIRS