Provider Demographics
NPI:1164475091
Name:JEFFERSON HILLS SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:JEFFERSON HILLS SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-469-7110
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-7110
Mailing Address - Fax:412-469-8938
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 150
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-7110
Practice Address - Fax:412-469-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017401990002Medicaid
PA102792OtherUPMC FOR LIFE
PA876903OtherFIRST HEALTH
PA89940OtherUNISON
PA020041924OtherUNITED HEALTHCARE
PA2110489OtherAETNA
PA7728259OtherCIGNA
PA2119OtherUPMC FOR YOU
PA1538038OtherUMWA
PACI6850OtherPALMETTO GBA RR MEDICARE
PA076046OtherHIGHMARK PROVIDER NUMBER
PA024095Medicare ID - Type UnspecifiedMEDICARE GROUP