Provider Demographics
NPI:1376148593
Name:UNITED SURGEONS, LLC
Entity Type:Organization
Organization Name:UNITED SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEN-MARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-231-6800
Mailing Address - Street 1:4455 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1414
Mailing Address - Country:US
Mailing Address - Phone:574-231-6800
Mailing Address - Fax:574-231-6845
Practice Address - Street 1:4455 EDISON LAKES PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1414
Practice Address - Country:US
Practice Address - Phone:574-231-6800
Practice Address - Fax:574-231-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty