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Organization
MT AIRY AMBULATORY ENDOSCOPY SURGERY CENTER
Active
Organization
MT AIRY AMBULATORY ENDOSCOPY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES STEVEN BLAKE DO (CEO/MEDICAL DIRECTOR/ADMINISTRATOR)
(215) 849-4902
Entity
Organization
Contact information
Practice address
6827-31 GERMANTOWN AVE, PHILADEPPHIA, PA 19119-2113
(215) 849-4902
(215) 849-4902
Mailing address
P.O. BOX 5651, PHILADELPHIA, PA 19129
(215) 849-4902
(215) 849-4907
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2034
PA
Other
Enumeration date
10/31/2006
Last updated
06/03/2011
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