1447220082 NPI number — WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC

Table of content: (NPI 1447220082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447220082 NPI number — WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC
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:
WESTERN PA SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1447220082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6001 STONEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-7380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-933-3800
Provider Business Mailing Address Fax Number:
724-933-3801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 STONEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-7380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-933-3800
Provider Business Practice Location Address Fax Number:
724-933-3801
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTERBAUGH
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
724-933-3800

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  20221501 , 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: 000000113869 . This is a "THREE RIVERS HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1352 . This is a "HIGHMARK BLUE CROSS/SHIEL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1526540 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001829689 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2299818002 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 214838 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 490004868 . This is a "PALMETTORAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 043308 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2429070 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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