1992734677 NPI number — TRUESDALE SURGICAL ASSOCIATES INC

Table of content: (NPI 1992734677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992734677 NPI number — TRUESDALE SURGICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUESDALE SURGICAL ASSOCIATES INC
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:
1992734677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 PRESIDENT AVE
Provider Second Line Business Mailing Address:
SUITE 3002
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-676-3411
Provider Business Mailing Address Fax Number:
508-676-0932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 PRESIDENT AVE
Provider Second Line Business Practice Location Address:
SUITE 3002
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-676-3411
Provider Business Practice Location Address Fax Number:
508-676-0932
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONCHIK
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-676-3411

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C201 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43137 . This is a "BS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1709090 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: S014348 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008822 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 605004 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9754156 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TS05277 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0124523 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M14632 . This is a "MASS BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CB5955 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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