Provider Demographics
NPI:1528398534
Name:ADVANCED SURGICAL HOSPITAL LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:L LOYD
Authorized Official - Middle Name:WILBER
Authorized Official - Last Name:SCARROW
Authorized Official - Suffix:JR
Authorized Official - Credentials:FACHE
Authorized Official - Phone:724-884-0710
Mailing Address - Street 1:100 TRICH DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5987
Mailing Address - Country:US
Mailing Address - Phone:724-884-0710
Mailing Address - Fax:724-884-0721
Practice Address - Street 1:100 TRICH DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5987
Practice Address - Country:US
Practice Address - Phone:724-884-0710
Practice Address - Fax:724-884-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025352750002Medicaid
PA1025352750002Medicaid