1275588600 NPI number — SURGICAL ASSOCIATES OF WESTERN NY PC

Table of content: (NPI 1275588600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275588600 NPI number — SURGICAL ASSOCIATES OF WESTERN NY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES OF WESTERN NY PC
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:
1275588600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 ORCHARD PARK RD
Provider Second Line Business Mailing Address:
A103
Provider Business Mailing Address City Name:
WEST SENECA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224-2646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-677-5500
Provider Business Mailing Address Fax Number:
716-677-5008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 ORCHARD PARK RD
Provider Second Line Business Practice Location Address:
A103
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-677-5500
Provider Business Practice Location Address Fax Number:
716-677-5008
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASMUSSON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-677-5500

Provider Taxonomy Codes

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

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

  • Identifier: 00502623001 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01226342 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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