Organization
COMMUNITY SURGERY & LASER CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE B DAVIS (CHIEF REVENUE CYCLE OFFICER)
(916) 990-7590
Entity
Organization
Contact information
Practice address
2 FARM COLONY DRIVE, WARREN, PA 16365-5206
(814) 726-2303
(404) 305-3199
Mailing address
2 FARM COLONY DRIVE, WARREN, PA 16365-5206
(814) 726-2303
(814) 726-7459
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
20821501
PA
261QA1903X
Ambulatory Surgical Clinic/Center
MD052930L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154-823-4255
NPI-DR. GORDON WUEBBOLT
PA
Enumeration date
07/26/2006
Last updated
12/03/2024
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