Organization
EVANGELICAL AMBULATORY SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM J. MALONEY (CHIEF FINANCIAL OFFICER)
(570) 524-6700
Entity
Organization
Contact information
Practice address
210 JPM RD, LEWISBURG, PA 17837-9367
(570) 524-6700
(570) 524-6710
Mailing address
210 JPM RD, LEWISBURG, PA 17837-9367
(570) 524-6700
(570) 524-6710
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
14631501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0167726
DEPARTMENT OF LABOR PROV#
PA
05
—
1007755680001
—
PA
01
—
151805
HEALTH AMERICA PROV#
PA
01
—
155458XX
PREFERRED CARE
PA
01
—
1599
HIGHMARK BLUESHIELD
PA
01
—
20025739
AMERIHEALTH PROVIDER NUMB
PA
01
—
390839
CAPITAL BLUE CROSS
PA
01
—
39C0001119
STERLING OPTION I
PA
01
—
490005320
RAILROAD MEDICARE
PA
01
—
79197
GEISINGER HEALTH PLAN
PA
Enumeration date
09/15/2005
Last updated
04/22/2008
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