Provider Demographics
NPI:1689860124
Name:PINE GROVE AMBULATORY SURGICAL
Entity type:Organization
Organization Name:PINE GROVE AMBULATORY SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:814-688-0426
Mailing Address - Street 1:10 TIMBERVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345
Mailing Address - Country:US
Mailing Address - Phone:814-757-5819
Mailing Address - Fax:814-757-5829
Practice Address - Street 1:10 TIMBERVIEW LANE
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345
Practice Address - Country:US
Practice Address - Phone:814-757-5819
Practice Address - Fax:814-757-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical