Provider Demographics
NPI:1447220082
Name:WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC
Entity Type:Organization
Organization Name:WESTERN PA SURGERY CENTER, WEXFORD BRANCH, LLC
Other - Org Name:WESTERN PA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-933-3800
Mailing Address - Street 1:6001 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7380
Mailing Address - Country:US
Mailing Address - Phone:724-933-3800
Mailing Address - Fax:724-933-3801
Practice Address - Street 1:6001 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7380
Practice Address - Country:US
Practice Address - Phone:724-933-3800
Practice Address - Fax:724-933-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20221501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000113869OtherTHREE RIVERS HEALTH PLAN
PA1352OtherHIGHMARK BLUE CROSS/SHIEL
PA1526540OtherGATEWAY HEALTH PLAN
PA001829689 0002Medicaid
PA2299818002OtherCIGNA
PA214838OtherUPMC HEALTH PLAN
GA490004868OtherPALMETTORAILROAD MEDICARE
PA043308OtherHEALTH AMERICA
PA2429070OtherAETNA US HEALTHCARE
PA1526540OtherGATEWAY HEALTH PLAN