Basic Information
| Provider Information | |||||||||
| NPI: | 1538115829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BANNING ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199043485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026740600 | ||||||||
| FaxNumber: | 3026727144 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BANNING ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199043485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026740600 | ||||||||
| FaxNumber: | 3026727144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3026740600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 020042247 | 01 | DE | RAILROAD MEDICARE | OTHER | 0000921602 | 05 | DE | MEDICAID |