# QITA ASC-HARRISBURG, LLC

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

## Provider details

- **NPI number:** 1588291686
- **Authorized official:** MR. BENJAMIN SLATER (CHIEF PRODUCT & STRATEGY OFFICER)
- **Authorized official phone:** (717) 932-6343

## Contact information

- **Practice address:** 815 SIR THOMAS CT, HARRISBURG, PA 17109-4839
- **Practice address phone:** (717) 938-2765
- **Mailing address:** 815 SIR THOMAS CT, HARRISBURG, PA 17109-4839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/26/2020
- **Last updated:** 03/26/2020