Kingston Ophthalmology ASC LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

KINGSTON OPHTHALMOLOGY ASC LLC

Doing business as

Kingston Surgery Center

Practice address

601 Wyoming Ave
Kingston, PA 18704-3701

Phone

(570) 288-7405

Fax

(570) 714-0419

NPI assigned

Apr 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Phillip A. Clendenin

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kingston Surgery Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1396919825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043701",
            "telephone_number": "570-288-7405",
            "fax_number": "570-714-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043701",
            "telephone_number": "570-288-7405",
            "fax_number": "570-714-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON OPHTHALMOLOGY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CLENDENIN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB1516",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1640867",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingston Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kingston Ophthalmology ASC LLC
• Kingston SNF Healthcare, LLC
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• Kingston Spine & Sport Physical Therapy PC
• Mary Kathleen Kirchner
• Jacqueline Kishbaugh, BCBA

• Anesthesiology Physician in Kingston, PA
• Providers in Kingston, PA by specialty
• Anesthesiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.