Basic Information
| Provider Information | |||||||||
| NPI: | 1013412287 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLUE BELL ASC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JEFFERSON SURGERY CENTER - BLUE BELL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11221 ROE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133870510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 518 EAST TOWNSHIP LINE RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133870510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | TASSET | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE CHAIR, NUEHEALTH | ||||||||
| AuthorizedOfficialTelephone: | 9133870510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.