Organization
LIBERTY EYE SURGICAL CENTER
Active
Other names
Liberty Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD MICHAEL QUINN (ADMINISTRATOR)
(215) 673-9231
Entity
Organization
Contact information
Practice address
9122 BLUE GRASS RD, PHILADELPHIA, PA 19114-3202
(215) 673-9231
(215) 673-9236
Mailing address
9122 BLUE GRASS RD, PHILADELPHIA, PA 19114-3202
(215) 673-9231
(215) 673-9236
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
17401501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009642060001
—
PA
Enumeration date
01/25/2007
Last updated
08/22/2020
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