Provider Demographics
NPI:1003851742
Name:SURGICAL SPECIALISTS OF HAZLETON, P. C.
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF HAZLETON, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMEED
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-501-6900
Mailing Address - Street 1:HEALTH & WELLNESS CENTER
Mailing Address - Street 2:50 MOISEY DRIVE SUITE 214
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202
Mailing Address - Country:US
Mailing Address - Phone:570-501-6900
Mailing Address - Fax:570-501-6945
Practice Address - Street 1:HEALTH & WELLNESS CENTER
Practice Address - Street 2:50 MOISEY DRIVE SUITE 214
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-501-6900
Practice Address - Fax:570-501-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016137400005Medicaid
PA0016137400005Medicaid