Provider Demographics
NPI:1073580395
Name:BEDFORD SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BEDFORD SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-623-1002
Mailing Address - Street 1:283 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7020
Mailing Address - Country:US
Mailing Address - Phone:814-623-1002
Mailing Address - Fax:814-623-2982
Practice Address - Street 1:283 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7020
Practice Address - Country:US
Practice Address - Phone:814-623-1002
Practice Address - Fax:814-623-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065086L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFA1393783OtherPA BLUE SHIELD
PA218988OtherUPMC HEALTH PLAN
PA0019206600001Medicaid
PA218988OtherUPMC HEALTH PLAN
PAH39917Medicare UPIN