Provider Demographics
NPI:1053575852
Name:EYNON SURGERY CENTER, LLC
Entity type:Organization
Organization Name:EYNON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6153-456-6900
Mailing Address - Street 1:401 COMMERCE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2446
Mailing Address - Country:US
Mailing Address - Phone:615-345-6900
Mailing Address - Fax:615-691-7214
Practice Address - Street 1:681 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1022
Practice Address - Country:US
Practice Address - Phone:570-876-5900
Practice Address - Fax:570-876-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102268144 0001Medicaid
PA134727Medicare PIN