Provider Demographics
NPI:1457320095
Name:ERIE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ERIE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-483-6655
Mailing Address - Street 1:1400 WEST MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811
Mailing Address - Country:US
Mailing Address - Phone:419-483-6655
Mailing Address - Fax:416-483-6699
Practice Address - Street 1:1400 WEST MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811
Practice Address - Country:US
Practice Address - Phone:419-483-6655
Practice Address - Fax:416-483-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2631218Medicaid
OHDD6136OtherRAILROAD MEDICARE
OH7368728OtherAETNA
OHDD6136OtherRAILROAD MEDICARE
OH2631218Medicaid
OH9355821Medicare PIN