Basic Information
Provider Information
NPI: 1487671251
EntityType: 2
ReplacementNPI:  
OrganizationName: SURGICAL ASSOCIATES OF MADISON COUNTY, PC
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Mailing Information
Address1: 2001 N GRANVILLE AVE
Address2:  
City: MUNCIE
State: IN
PostalCode: 473032110
CountryCode: US
TelephoneNumber: 7652133238
FaxNumber: 7652842434
Practice Location
Address1: 1210 MEDICAL ARTS BLVD
Address2: SUITE 215
City: ANDERSON
State: IN
PostalCode: 460113461
CountryCode: US
TelephoneNumber: 7652984140
FaxNumber: 7652842434
Other Information
ProviderEnumerationDate: 07/16/2006
LastUpdateDate: 02/03/2015
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AuthorizedOfficialLastName: MCCURDY
AuthorizedOfficialFirstName: DWIGHT
AuthorizedOfficialMiddleName: BENJAMIN
AuthorizedOfficialTitleorPosition: PARTNER
AuthorizedOfficialTelephone: 7652984140
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
20023686005IN MEDICAID
200039730A05IN MEDICAID
200442460A05IN MEDICAID


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