Organization
MIFFLIN COUNTY COMMUNITY SURGICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN D GORDON MD (PRESIDENT)
(717) 242-2514
Entity
Organization
Contact information
Practice address
311 4TH ST, LEWISTOWN, PA 17044-1316
(717) 242-9565
(717) 242-9510
Mailing address
27 SANDY LN STE 220, LEWISTOWN, PA 17044-1320
(717) 242-4805
(717) 242-5900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10611500-PII
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017198290003
—
PA
01
—
1751
HIGHMARK BLUE SHIELD
PA
01
—
390822
CAPITAL BLUE CROSS
PA
Enumeration date
03/28/2007
Last updated
11/16/2011
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