Provider Demographics
NPI:1225138944
Name:GENERAL SURGERY ASSOCIATES INC
Entity Type:Organization
Organization Name:GENERAL SURGERY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-886-1247
Mailing Address - Street 1:PO BOX 72064
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:440-808-3700
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:6707 POWERS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5455
Practice Address - Country:US
Practice Address - Phone:440-886-1247
Practice Address - Fax:440-886-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGE9266811Medicare ID - Type Unspecified