| Organization Name: | MAIN LINE PA ENDOSCOPY ASC LP |
| NPI Number: | 1023115078 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILLIP A CLENDENIN (PRESIDENT) |
| Mailing Address: | 325 West Central Ave Lower Level Malvern |
| State: | PA US |
| Postal Code: | 193553219 |
| Phone Number: | 6106447274 |
| Fax Number: | 6106447276 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 04/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 15801501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |