Organization
SURGERY CENTER OF PENNSYLVANIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH TUCKER R.N. (DIRECTOR)
(610) 853-7700
Entity
Organization
Contact information
Practice address
2010 W CHESTER PIKE, SUITE 212, HAVERTOWN, PA 19083-2700
(610) 853-7700
(610) 853-7755
Mailing address
2010 W CHESTER PIKE, SUITE 212, HAVERTOWN, PA 19083-2700
(610) 853-7700
(610) 853-7755
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10271500
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618000
KEYSTONE HEALTH PLAN EAST
PA
05
—
0019414000001
—
PA
01
—
1618
INDEPENDENCE BLUE CROSS
PA
01
—
30005351
KEYSTONE MERCY HEALTH PLA
PA
01
—
3052119
AETNA
PA
Enumeration date
07/16/2006
Last updated
08/22/2020
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