Provider Demographics
NPI:1831803345
Name:ADVANCED SURGICAL AMBULATORY PARTNERS OF HAVERTOWN
Entity type:Organization
Organization Name:ADVANCED SURGICAL AMBULATORY PARTNERS OF HAVERTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-651-8180
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-0358
Mailing Address - Country:US
Mailing Address - Phone:484-434-7500
Mailing Address - Fax:484-434-7501
Practice Address - Street 1:700 E TOWNSHIP LINE RD FL 2
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:484-434-7500
Practice Address - Fax:484-434-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical