Organization
MT AIRY AMBULATORY ENDOSCOPY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES STEVEN BLAKE DO (CEO/MEDICAL DIRECTOR/ADMINISTRATOR)
(215) 849-4902
Entity
Organization
Contact information
Practice address
6827-31 GERMANTOWN AVE, PHILADEPPHIA, PA 19119-2113
(215) 849-4902
(215) 849-4902
Mailing address
P.O. BOX 5651, PHILADELPHIA, PA 19129
(215) 849-4902
(215) 849-4907
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2034
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101729710-001
—
PA
Enumeration date
10/31/2006
Last updated
06/03/2011
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