Provider Demographics
NPI:1174525661
Name:HANOVER SURGICENTER, L.L.C.
Entity type:Organization
Organization Name:HANOVER SURGICENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:717-637-1600
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUIE 130
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-633-1600
Mailing Address - Fax:717-633-6556
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-633-1600
Practice Address - Fax:717-633-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA01681500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106979Medicare PIN