Provider Demographics
| NPI: | 1497707517 |
|---|---|
| Name: | EVANSVILLE SURGICAL ASSOCIATES INC |
| Entity Type: | Organization |
| Organization Name: | EVANSVILLE SURGICAL ASSOCIATES INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF FINANCE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | HEIDI |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | PETRIG |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 812-424-8231 |
| Mailing Address - Street 1: | 520 MARY ST |
| Mailing Address - Street 2: | SUITE 520 |
| Mailing Address - City: | EVANSVILLE |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 47710-1682 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 812-424-8231 |
| Mailing Address - Fax: | 812-435-8794 |
| Practice Address - Street 1: | 520 MARY ST STE 520 |
| Practice Address - Street 2: | |
| Practice Address - City: | EVANSVILLE |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 47710-1682 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 812-424-8231 |
| Practice Address - Fax: | 812-435-8794 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-17 |
| Last Update Date: | 2024-03-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | Group - Multi-Specialty |
| No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | Group - Multi-Specialty |
| No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 246ZC0007X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Surgical Assistant | Group - Multi-Specialty |
| No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 101081 | Other | BCBS - GROUP | |
| IN | 196912-153 | Other | IN LICENSE |
| KY | 7100261010 | Other | KY GROUP MEDICAID - PHYSICIAN ASSISTANT |
| KY | 7100229330 | Other | KY GROUP MEDICAID -PHYSICIANS |
| IN | 100241430A | Medicaid | |
| KY | 7100164050 | Other | KY GROUP MEDICAID - NURSE PRACTITIONERS |
