Provider Demographics
NPI:1548223654
Name:SPARTAN HEALTH SURGICENTER LLC
Entity Type:Organization
Organization Name:SPARTAN HEALTH SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-483-2760
Mailing Address - Street 1:100 STOOPS DRIVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063
Mailing Address - Country:US
Mailing Address - Phone:724-483-2760
Mailing Address - Fax:724-483-2762
Practice Address - Street 1:100 STOOPS DRIVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-483-2760
Practice Address - Fax:724-483-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1552261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014402660001Medicaid
PA094828Medicare PIN