Provider Demographics
NPI:1992768048
Name:LEBANON OUTPATIENT SURGICAL CENTER L.P.
Entity type:Organization
Organization Name:LEBANON OUTPATIENT SURGICAL CENTER L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BS,CASC
Authorized Official - Phone:717-228-1620
Mailing Address - Street 1:830 TUCK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7477
Mailing Address - Country:US
Mailing Address - Phone:717-228-1620
Mailing Address - Fax:717-228-1642
Practice Address - Street 1:830 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7477
Practice Address - Country:US
Practice Address - Phone:717-228-1620
Practice Address - Fax:717-228-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05781500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA718200OtherHEALTH AMERICAHEALTH ASSU
PA001449984001Medicaid
PA1519405OtherGATEWAY HEALTH PLAN
PA390708OtherBLUE CROSS
PA501572OtherAETNA
PA1600OtherHIGHMARK BLUE SHIELD
PA390708OtherBLUE CROSS