Provider Demographics
NPI:1538115829
Name:SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-674-0600
Mailing Address - Street 1:200 BANNING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-674-0600
Mailing Address - Fax:302-672-7144
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:STE 200
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-674-0600
Practice Address - Fax:302-672-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE020042247OtherRAILROAD MEDICARE
DE0000921602Medicaid
DEG00172Medicare ID - Type Unspecified