Surgery Center of Lebanon, LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1893 Issued in PA

Legal business name

SURGERY CENTER OF LEBANON, LP

Doing business as

PHYSICIANS SURGICAL CENTER

Practice address

1840 Quentin Rd
Lebanon, PA 17042-7436

Phone

(717) 272-0007

Fax

(717) 675-2247

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5954

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PHYSICIANS SURGICAL CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Physicians Surgery Center of LebanonCCN 39C0001190

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Eye Consultants of Pennsylvania, PC

  • Ophthalmology Physician
  • Wyomissing, PA
  • NPI 1033181904

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1679595680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 QUENTIN RD",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427436",
            "telephone_number": "717-272-0007",
            "fax_number": "717-675-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 QUENTIN RD",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427436",
            "telephone_number": "717-272-0007",
            "fax_number": "717-675-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF LEBANON, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2023-03-07",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "1893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOH LICENSURE NUMBER",
            "identifier": "1893",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101425401",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIANS SURGICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHYSICIANS SURGICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Suleski
• Kara Summers
• Sundance Rehabilitation Agency LLC
• Andrew Murphy Superdock, D.M.D.
• Ellen R Superdock, CRNP
• Emily Alexandra Swanger, CCC-SLP
• Jennifer Swanson
• Jerome Swierczynski, CRNA
• Charles Marvin Swingholm, R.N.
• Jennifer Lyn Swope, LCSW

• Ambulatory Surgical Clinic/Center in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.