Provider Demographics
NPI:1194718940
Name:20-20 SURGERY CENTER LLC
Entity type:Organization
Organization Name:20-20 SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:KING
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-836-1177
Mailing Address - Street 1:516 PELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4506
Mailing Address - Country:US
Mailing Address - Phone:724-836-1177
Mailing Address - Fax:724-836-4700
Practice Address - Street 1:516 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4506
Practice Address - Country:US
Practice Address - Phone:724-836-1177
Practice Address - Fax:724-836-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17611501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012051400001Medicaid
PA087623Medicare PIN