Provider Demographics
NPI:1780919043
Name:SURGERY CENTER OF EDGEWOOD PLACE, LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF EDGEWOOD PLACE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-646-0400
Mailing Address - Street 1:239 EDGEWOOD DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:TRANSFER
Mailing Address - State:PA
Mailing Address - Zip Code:16154-1817
Mailing Address - Country:US
Mailing Address - Phone:724-646-0400
Mailing Address - Fax:724-646-0413
Practice Address - Street 1:2 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2354
Practice Address - Country:US
Practice Address - Phone:724-656-9181
Practice Address - Fax:724-656-1340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGERY CENTER AT EDGEWOOD PLACE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-05
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical