Basic Information
| Provider Information | |||||||||
| NPI: | 1275895328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUN SURGICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 BUFFALO RD | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178371206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705244446 | ||||||||
| FaxNumber: | 5705221110 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 JPM RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705246700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 06/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5705244446 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.