Provider Demographics
NPI:1043264161
Name:BETHLEHEM SURGICAL CENTER PC
Entity type:Organization
Organization Name:BETHLEHEM SURGICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:PARAYNO
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-867-2371
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:STE 504
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1153
Mailing Address - Country:US
Mailing Address - Phone:610-867-2371
Mailing Address - Fax:610-868-7889
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 504
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1153
Practice Address - Country:US
Practice Address - Phone:610-867-2371
Practice Address - Fax:610-868-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA155987Medicare ID - Type Unspecified