Provider Demographics
NPI:1174634778
Name:THE CENTER FOR SPECIALIZED SURGERY, LP
Entity Type:Organization
Organization Name:THE CENTER FOR SPECIALIZED SURGERY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-664-4100
Mailing Address - Street 1:8164 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:484-821-0550
Mailing Address - Fax:484-821-0559
Practice Address - Street 1:2851 BAGLYOS CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8038
Practice Address - Country:US
Practice Address - Phone:484-821-0550
Practice Address - Fax:484-821-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017725980001Medicaid
PAP00336342OtherRAILROAD MEDICARE PTAN
PA103445Medicare ID - Type Unspecified