| Full Name | |
|---|---|
| Speciality | Clinic/center - Ambulatory Surgical |
| Location | 250 S 21st St, Easton, Pennsylvania |
| Authorized Official Name and Position | Gary Newsome (PRESIDENT GROUP OPERATIONS) |
| Authorized Official Contact | 6154657000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 503786 Saint Louis MO 63150-0001 Ph: (610) 250-4000 | 250 S 21st St Easton PA 18042-3851 Ph: (610) 250-4000 |
| NPI Number | 1902012289 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902012289 | NPI | - | NPPES |
| 1007525900009 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 310401 (Pennsylvania) | Primary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | 310401 (Pennsylvania) | Primary |
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