Provider Demographics
NPI:1548215296
Name:RECTAL AND COLON SURGERY INC
Entity Type:Organization
Organization Name:RECTAL AND COLON SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-2976
Mailing Address - Street 1:3216 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2822
Mailing Address - Country:US
Mailing Address - Phone:814-456-2976
Mailing Address - Fax:814-456-9613
Practice Address - Street 1:3216 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2822
Practice Address - Country:US
Practice Address - Phone:814-456-2976
Practice Address - Fax:814-456-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006427000001Medicaid
PA36594Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER