# LOG SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326632936
- **Authorized official:** LUCILLE FORMEISTER (DIRECTOR, BUSINESS SYSTEMS)
- **Authorized official phone:** (860) 667-9542

## Contact information

- **Practice address:** 413 GRANITE RUN DR, LANCASTER, PA 17601-6809
- **Practice address phone:** (860) 667-9542
- **Mailing address:** 413 GRANITE RUN DR, LANCASTER, PA 17601-6809
- **Mailing address phone:** (860) 667-9542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/24/2021
- **Last updated:** 06/15/2021