Provider Demographics
NPI:1487671251
Name:SURGICAL ASSOCIATES OF MADISON COUNTY, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MADISON COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-298-4140
Mailing Address - Street 1:2001 N GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2110
Mailing Address - Country:US
Mailing Address - Phone:765-213-3238
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:1210 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4140
Practice Address - Fax:765-284-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200236860Medicaid
IN200039730AMedicaid
IN200442460AMedicaid
505410EMedicare ID - Type UnspecifiedDR. BAER
IN200236860Medicaid
IN200442460AMedicaid
G97693Medicare UPIN
G06846Medicare UPIN