Provider Demographics
NPI:1134269483
Name:GETTYSBURG AMBULATORY SURGICAL CENTER LLC
Entity type:Organization
Organization Name:GETTYSBURG AMBULATORY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VP
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-936-9186
Mailing Address - Street 1:236 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2509
Mailing Address - Country:US
Mailing Address - Phone:717-338-4500
Mailing Address - Fax:717-334-6996
Practice Address - Street 1:236 WEST ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2509
Practice Address - Country:US
Practice Address - Phone:717-338-4500
Practice Address - Fax:717-334-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2152151261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116787Medicare PIN