Basic Information
| Provider Information | |||||||||
| NPI: | 1194027920 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRANT SURGICENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 GRANT AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191157287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159926000 | ||||||||
| FaxNumber: | 2159926001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 GRANT AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191157287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159926000 | ||||||||
| FaxNumber: | 2159926001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2010 | ||||||||
| LastUpdateDate: | 11/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZONSHAYN | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2159926000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.