Basic Information
| Provider Information | |||||||||
| NPI: | 1922301324 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOURDES SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 WHITE HORSE PIKE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565463900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 WHITE HORSE PIKE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565463900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8567969356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NNO8583700 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.