Provider Demographics
NPI:1306434998
Name:AMBULATORY SURGERY CENTER OF BALA CYNWYD, LLC
Entity type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF BALA CYNWYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TRICOLI
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:407-947-3084
Mailing Address - Street 1:660 PALM SPRINGS DR STE C
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7864
Mailing Address - Country:US
Mailing Address - Phone:407-960-7990
Mailing Address - Fax:321-972-4252
Practice Address - Street 1:100 PRESIDENTIAL BLVD FL 4
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:407-960-7990
Practice Address - Fax:321-972-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical