Organization
KINGSTON OPHTHALMOLOGY ASC LLC
Active
Other names
Kingston Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
601 WYOMING AVE, KINGSTON, PA 18704-3701
(570) 288-7405
(570) 714-0419
Mailing address
601 WYOMING AVE, KINGSTON, PA 18704-3701
(570) 288-7405
(570) 714-0419
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
94941500
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001696312001
MEDICAL ASSISTANCE
PA
05
—
01835908
—
PA
01
—
490003620
RAILROAD MEDICARE
PA
01
—
804568
FIRST PRIORITY HEALTH
PA
01
—
999035
BLUE CROSS
PA
Enumeration date
02/08/2006
Last updated
09/07/2023
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