1174521959 NPI number — UNITED SURGICAL ASSOCIATES, P.C

Table of content: (NPI 1174521959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174521959 NPI number — UNITED SURGICAL ASSOCIATES, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED SURGICAL ASSOCIATES, P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174521959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 N SCOTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18407-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-281-9000
Provider Business Mailing Address Fax Number:
570-281-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 N SCOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-9000
Provider Business Practice Location Address Fax Number:
570-281-9200
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WROBLESKI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-281-9000

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  OS009172L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: OS009172L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202975 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 814383 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119234 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1989020 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3Y2164 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 925496 . This is a "BLUE SHIELD INDIVIUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0077428240002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2587081 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 343958 . This is a "HEALTHAMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001364500 . This is a "BLUE SHIELD GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 66699 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2741545 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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